Provider Demographics
NPI:1629555032
Name:WOODS, GRACE SHIRLEY (PA-C)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:SHIRLEY
Last Name:WOODS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4910 DIRECTORS PL STE 350
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-3834
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4910 DIRECTORS PL STE 350
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-3834
Practice Address - Country:US
Practice Address - Phone:858-571-9550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-27
Last Update Date:2023-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA55813363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1151742OtherNON-MEDICARE
CA1151742OtherCERTIFICATION BY THE NATIONAL COMMISSION ON CERTIFICATION OF PHYSICIAN ASSISTANT