Healthcare Provider Details

I. General information

NPI: 1861620395
Provider Name (Legal Business Name): RACHEL LYNN WOOD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2009
Last Update Date: 01/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 S GRAND AVE
SANTA ANA CA
92705-4121
US

IV. Provider business mailing address

149 LINDEN AVE PENTHOUSE
LONG BEACH CA
90802-4966
US

V. Phone/Fax

Practice location:
  • Phone: 714-667-7613
  • Fax:
Mailing address:
  • Phone: 415-828-5190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: