Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath | AC10818 | CA |
NPI | 1154497832 |
---|---|
Provider Name | Mr. Michael David Woodworth |
First Address | Oceanside, CA 92054 |
Second Address | Oceanside, CA 92054 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0007357745 | AETNA (01) | CA |
671144 | CONNECTICARE (01) | CA |
CA0108180 | BLUE SHIELD (01) |