MEDICARE: MRS. QUY-TRAN PHI WOODWARD M.A., CCC-A

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	231H00000X	Audiologist	AU2152	CA

General Provider Information

NPI Number	:	1720016165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. QUY-TRAN PHI WOODWARD M.A., CCC-A

Provider Business Mailing Address
First Line	:	FILE #55745
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90074-5745
Country	:	US
Telephone Number	:	818-768-6447
Fax Number	:	818-768-6888

Provider Business Practice Location Address
First Line	:	8341 LAUREL CANYON BLVD
Second Line	:
City	:	SUN VALLEY
State	:	CA
Zip	:	91352-3809
Country	:	US
Telephone Number	:	818-768-6447
Fax Number	:	818-768-6888

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

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	01/16/2009

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