Healthcare Provider Details

I. General information

NPI: 1558370106
Provider Name (Legal Business Name): SUSAN TRENT WOODARD SR. RN,NPC,MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3445 PACIFIC COAST HWY SUITE 100
TORRANCE CA
90505-6658
US

IV. Provider business mailing address

3445 PACIFIC COAST HWY SUITE 100
TORRANCE CA
90505-6658
US

V. Phone/Fax

Practice location:
  • Phone: 310-257-0508
  • Fax: 310-781-1424
Mailing address:
  • Phone: 310-257-0508
  • Fax: 310-781-1424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number280321
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: