1164085593 NPI number — LINDA ANN WOODY-GODSAVE NP

Table of content: LINDA ANN WOODY-GODSAVE NP (NPI 1164085593)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164085593 NPI number — LINDA ANN WOODY-GODSAVE NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOODY-GODSAVE
Provider First Name:
LINDA
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GODSAVE
Provider Other First Name:
LINDA
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN, NP
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1164085593
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/22/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10206 GENESTA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTHRIDGE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91325-1627
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-404-0664
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1250 LA VENTA DR STE 112
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WESTLAKE VILLAGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91361-3756
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-496-5153
Provider Business Practice Location Address Fax Number:
805-496-5202
Provider Enumeration Date:
04/22/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  95011321 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)