Provider Demographics
NPI:1194816322
Name:WOOD, PATRICIA LOUISE (PHD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:LOUISE
Last Name:WOOD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 LUCAS CT
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-3314
Mailing Address - Country:US
Mailing Address - Phone:805-375-8382
Mailing Address - Fax:
Practice Address - Street 1:500 E ESPLANADE DR
Practice Address - Street 2:SUITE 860
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-2110
Practice Address - Country:US
Practice Address - Phone:805-375-8382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 19477103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP19477Medicare ID - Type Unspecified
CAQ11005Medicare UPIN