Provider Demographics
NPI:1942236716
Name:WOOD, DENNIS PATRICK (PHD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:PATRICK
Last Name:WOOD
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 1:1050 B AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:CORONADO
Mailing Address - State:CA
Mailing Address - Zip Code:92118-3430
Mailing Address - Country:US
Mailing Address - Phone:619-437-0355
Mailing Address - Fax:
Practice Address - Street 1:1050 B AVE
Practice Address - Street 2:SUITE B
Practice Address - City:CORONADO
Practice Address - State:CA
Practice Address - Zip Code:92118-3430
Practice Address - Country:US
Practice Address - Phone:619-437-0355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-24
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 19293103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP19293Medicare PIN