Provider Demographics
NPI:1336130350
Name:WOODMAN, ROB (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROB
Middle Name:
Last Name:WOODMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2655 PORTAGE BAY E
Mailing Address - Street 2:SUITE 8
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-3073
Mailing Address - Country:US
Mailing Address - Phone:530-902-1683
Mailing Address - Fax:
Practice Address - Street 1:2655 PORTAGE BAY E
Practice Address - Street 2:SUITE 8
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-3073
Practice Address - Country:US
Practice Address - Phone:530-902-1683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-31
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13069103G00000X, 103TB0200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY130690Medicaid
CAOPL130690Medicare ID - Type Unspecified
CAPSY130690Medicaid