Healthcare Provider Details

I. General information

NPI: 1669809315
Provider Name (Legal Business Name): GREGORY WOODS RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2013
Last Update Date: 09/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 STOCKTON BLVD
SACRAMENTO CA
95817-2201
US

IV. Provider business mailing address

7727 MALLON CT
SACRAMENTO CA
95829-6601
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-7771
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number839001
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: