Provider Demographics
NPI:1124563564
Name:WOODBURY ASSOCIATES, LLC
Entity Type:Organization
Organization Name:WOODBURY ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:CONSTABLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-232-1988
Mailing Address - Street 1:9891 IRVINE CENTER DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-4317
Mailing Address - Country:US
Mailing Address - Phone:949-232-1988
Mailing Address - Fax:949-232-1983
Practice Address - Street 1:9891 IRVINE CENTER DR
Practice Address - Street 2:SUITE 200
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-4317
Practice Address - Country:US
Practice Address - Phone:949-232-1988
Practice Address - Fax:949-232-1983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-20
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty