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General NPI Number Information
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NPI Number | 1295156271
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Entity Type | Organization
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Legal Business Name | SOUTHLAND MEDICAL GROUP,LLC
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Dates
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Enumeration Date | 12/18/2013
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Last Update Date | 12/18/2013
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Provider Practice Location Address
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Address Line | 17870 NEWHOPE ST., SUITE 104-276
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708
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Country | US
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Telephone | 171-463-6373
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Fax |
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Provider Business Mailing Address
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Address Line | 17870 NEWHOPE ST., SUITE 104-276
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708
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Country | US
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Telephone | 171-463-6373
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. ARTIS WOODWARD
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Credential | MD
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Telephone | 714-636-3736
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | A40488
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License Number State | CA
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