Healthcare Provider Details

I. General information

NPI: 1144140039
Provider Name (Legal Business Name): TONY WOODS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3155 E PATRICK LN
LAS VEGAS NV
89120-3496
US

IV. Provider business mailing address

3155 E PATRICK LN
LAS VEGAS NV
89120-3496
US

V. Phone/Fax

Practice location:
  • Phone: 702-992-0576
  • Fax:
Mailing address:
  • Phone: 702-992-0576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: