MEDICARE: DR. SAMUEL HORACE WOOD M.D., PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	G68058	CA

General Provider Information

NPI Number	:	1619076635
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMUEL HORACE WOOD M.D., PH.D.

Provider Business Mailing Address
First Line	:	3420 CARMEL MOUNTAIN RD STE 200
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-1069
Country	:	US
Telephone Number	:	858-267-4365
Fax Number	:	858-225-3535

Provider Business Practice Location Address
First Line	:	3420 CARMEL MOUNTAIN RD STE 200
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-1069
Country	:	US
Telephone Number	:	858-267-4365
Fax Number	:	858-225-3535

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	07/02/2019

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