Healthcare Provider Details

I. General information

NPI: 1033720719
Provider Name (Legal Business Name): LORA ANN WOOD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2020
Last Update Date: 04/10/2023
Certification Date: 04/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 SPRUCE ST STE 102
RIVERSIDE CA
92507-7403
US

IV. Provider business mailing address

1650 SPRUCE ST STE 102
RIVERSIDE CA
92507-7403
US

V. Phone/Fax

Practice location:
  • Phone: 951-357-6926
  • Fax: 855-568-2494
Mailing address:
  • Phone: 951-357-6926
  • Fax: 855-568-2494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: