Provider Demographics
NPI:1568714475
Name:WOODWORTH, PAULA SUE (CCAPP CICA 01780819)
Entity Type:Individual
Prefix:MS
First Name:PAULA
Middle Name:SUE
Last Name:WOODWORTH
Suffix:
Gender:F
Credentials:CCAPP CICA 01780819
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6800 OWENSMOUTH AVE STE 160
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91303-4255
Mailing Address - Country:US
Mailing Address - Phone:818-610-6754
Mailing Address - Fax:
Practice Address - Street 1:6800 OWENSMOUTH AVE STE 160
Practice Address - Street 2:
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91303
Practice Address - Country:US
Practice Address - Phone:818-610-6754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-03
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker