Provider Demographics
NPI:1013793363
Name:WOOD, LEA D (AGNP-C)
Entity Type:Individual
Prefix:
First Name:LEA
Middle Name:D
Last Name:WOOD
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 S PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-5115
Mailing Address - Country:US
Mailing Address - Phone:832-693-1158
Mailing Address - Fax:
Practice Address - Street 1:7630 E CHAPMAN AVE STE B
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92869-8536
Practice Address - Country:US
Practice Address - Phone:714-287-0459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-04
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95028155363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner