Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | DC27192 | CA |
NPI | 1497770515 |
---|---|
Provider Name | Dr. Gregory Guy Wood |
First Address | Costa Mesa, CA 92626-2964 |
Second Address | Costa Mesa, CA 92626-2964 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 08/07/2007 |