Healthcare Provider Details

I. General information

NPI: 1326259540
Provider Name (Legal Business Name): CAROLINE BERNARDINE WOODS RDHAP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2007
Last Update Date: 10/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3050 RUE DORLEANS UNIT 494
SAN DIEGO CA
92110-5927
US

IV. Provider business mailing address

3050 RUE DORLEANS UNIT 494
SAN DIEGO CA
92110-5927
US

V. Phone/Fax

Practice location:
  • Phone: 619-222-8697
  • Fax:
Mailing address:
  • Phone: 619-222-8697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberHAP130
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: