Healthcare Provider Details

I. General information

NPI: 1083376016
Provider Name (Legal Business Name): LINDA O WOODALL MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2021
Last Update Date: 10/07/2021
Certification Date: 10/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E DEL MAR BLVD STE 122
PASADENA CA
91105-2551
US

IV. Provider business mailing address

200 E DEL MAR BLVD STE 122
PASADENA CA
91105-2551
US

V. Phone/Fax

Practice location:
  • Phone: 626-235-0016
  • Fax:
Mailing address:
  • Phone: 626-235-0016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: LINIDA O WOODALL
Title or Position: MD
Credential: MD
Phone: 626-235-0016