Healthcare Provider Details

I. General information

NPI: 1528533361
Provider Name (Legal Business Name): DAQUINNISE LAURENA WOODARD MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2018
Last Update Date: 06/04/2024
Certification Date: 06/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23824 HAWTHORNE BLVD STE 200
TORRANCE CA
90505-5935
US

IV. Provider business mailing address

23824 HAWTHORNE BLVD STE 200
TORRANCE CA
90505-5935
US

V. Phone/Fax

Practice location:
  • Phone: 310-791-3064
  • Fax: 310-791-3084
Mailing address:
  • Phone: 310-791-3064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberASW91555
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: