Provider Demographics
NPI:1255396891
Name:DAVID K. WOODRUFF, AU.D. AN AUDIOLOGY CORPORATION
Entity type:Organization
Organization Name:DAVID K. WOODRUFF, AU.D. AN AUDIOLOGY CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:K
Authorized Official - Last Name:WOODRUFF
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:858-759-8922
Mailing Address - Street 1:PO BOX 524
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA FE
Mailing Address - State:CA
Mailing Address - Zip Code:92067-0524
Mailing Address - Country:US
Mailing Address - Phone:858-759-8922
Mailing Address - Fax:858-759-8022
Practice Address - Street 1:6037 LA GRANADA
Practice Address - Street 2:SUITE D
Practice Address - City:RANCHO SANTA FE
Practice Address - State:CA
Practice Address - Zip Code:92067-0524
Practice Address - Country:US
Practice Address - Phone:858-759-8922
Practice Address - Fax:858-759-8022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU1835231H00000X
CAAU1111231H00000X, 237600000X
CAHA2516237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAU001111OtherMEDI CAL NORTH COUNTY
CAAU0011110Medicaid
CAAU0011110Medicaid
AUD1111AMedicare ID - Type UnspecifiedNORTH COUNTY
CAAU001111OtherMEDI CAL NORTH COUNTY