Healthcare Provider Details

I. General information

NPI: 1972735751
Provider Name (Legal Business Name): SAMANTHA BROOKS WOOD SMITH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SAMANTHA BROOKS WOOD PA-C

II. Dates (important events)

Enumeration Date: 08/13/2009
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10956 DONNER PASS RD FL 2
TRUCKEE CA
96161-4861
US

IV. Provider business mailing address

10956 DONNER PASS RD FL 2
TRUCKEE CA
96161-4861
US

V. Phone/Fax

Practice location:
  • Phone: 530-587-6011
  • Fax:
Mailing address:
  • Phone: 530-587-6011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA20982
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: