1164879425 NPI number — MS. LISA HAROL WOOD CAODC

Table of content: MS. LISA HAROL WOOD CAODC (NPI 1164879425)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164879425 NPI number — MS. LISA HAROL WOOD CAODC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOOD
Provider First Name:
LISA
Provider Middle Name:
HAROL
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CAODC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164879425
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/24/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1153 OAK ST.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN FRANCISCO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94117
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-431-9000
Provider Business Mailing Address Fax Number:
415-431-1813

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1301 PIERCE ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN FRANCISCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-553-8200
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/17/2016

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: 101Y00000X , with the licence number:  RI-W1304250910 , 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)