Provider Demographics
NPI:1083117261
Name:WOOD, CARLA NICOLE (DO)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:NICOLE
Last Name:WOOD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W ARBOR DR # MC8466
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-1911
Mailing Address - Country:US
Mailing Address - Phone:619-543-7760
Mailing Address - Fax:619-543-6501
Practice Address - Street 1:200 W ARBOR DR # MC8466
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-1911
Practice Address - Country:US
Practice Address - Phone:619-543-7760
Practice Address - Fax:619-543-6501
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-14
Last Update Date:2023-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program