Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | DC26000 | CA |
NPI | 1992840110 |
---|---|
Provider Name | Alyssa M Woodall |
First Address | Westlake Village, CA 91361-2551 |
Second Address | Westlake Village, CA 91361-2551 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DC26000 | LICENSE (01) | CA |