=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982956082
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TERRY WAYNE WOODARD RCP
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/12/2012
-----------------------------------------------------
Last Update Date | 10/12/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 34740 BOROS BLVD.
-----------------------------------------------------
City | BEAUMONT
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92223
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-371-4514
-----------------------------------------------------
Fax | 951-755-7277
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 34740 BOROS BLVD
-----------------------------------------------------
City | BEAUMONT
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92223-7467
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-371-4514
-----------------------------------------------------
Fax | 951-755-7277
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2278G1100X
-----------------------------------------------------
Taxonomy Name | General Care Certified Respiratory Therapist
-----------------------------------------------------
License Number | 862
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------