Healthcare Provider Details

I. General information

NPI: 1871834283
Provider Name (Legal Business Name): ROSS WOODS M.A., B.C.B.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2013
Last Update Date: 10/07/2020
Certification Date: 10/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

236 GEORGIA ST SUITE 102
VALLEJO CA
94590-5991
US

IV. Provider business mailing address

PO BOX 4203
VALLEJO CA
94590-0420
US

V. Phone/Fax

Practice location:
  • Phone: 888-544-5553
  • Fax: 707-773-5575
Mailing address:
  • Phone: 888-544-5533
  • Fax: 888-722-7972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: