=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528533361
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAQUINNISE LAURENA WOODARD MSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/08/2018
-----------------------------------------------------
Last Update Date | 06/04/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 23824 HAWTHORNE BLVD STE 200
-----------------------------------------------------
City | TORRANCE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90505-5935
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-791-3064
-----------------------------------------------------
Fax | 310-791-3084
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23824 HAWTHORNE BLVD STE 200
-----------------------------------------------------
City | TORRANCE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90505-5935
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-791-3064
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | ASW91555
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------