Healthcare Provider Details

I. General information

NPI: 1790788347
Provider Name (Legal Business Name): JOSEPH PAUL WOODARD JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 10/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 AMGEN CENTER DR MS: 38-3-A
THOUSAND OAKS CA
91320-1730
US

IV. Provider business mailing address

2533 VISTA WOOD CIR APT 14
THOUSAND OAKS CA
91362-5703
US

V. Phone/Fax

Practice location:
  • Phone: 805-447-2339
  • Fax:
Mailing address:
  • Phone: 650-867-1985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License NumberC53334
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: