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General NPI Number Information
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NPI Number | 1487988655
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Entity Type | Organization
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Legal Business Name | RANDY WOOD PHD
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Dates
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Enumeration Date | 09/22/2009
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Last Update Date | 09/22/2009
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Provider Practice Location Address
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Address Line | 2580 E MAIN ST SUITE 100
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City | VENTURA
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State | CA
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Zip | 93003-2646
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Country | US
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Telephone | 805-653-6899
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Fax | 805-643-0022
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Provider Business Mailing Address
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Address Line | 2580 E MAIN ST SUITE 100
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City | VENTURA
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State | CA
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Zip | 93003-2646
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Country | US
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Telephone | 805-653-6899
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Fax | 805-643-0022
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | RANDY WOOD
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Credential | PH.D.
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Telephone | 805-653-6899
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY7570
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License Number State | CA
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