Healthcare Provider Details

I. General information

NPI: 1104018498
Provider Name (Legal Business Name): MARGARITA MERCEDES WOODBURY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2007
Last Update Date: 08/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2930 CAMINO DIABLO SUITE 200
WALNUT CREEK CA
94597-3986
US

IV. Provider business mailing address

2930 CAMINO DIABLO SUITE 200
WALNUT CREEK CA
94597-3986
US

V. Phone/Fax

Practice location:
  • Phone: 925-938-3757
  • Fax:
Mailing address:
  • Phone: 925-938-3757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG068352
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: