Provider Demographics
NPI:1740054246
Name:WOODWARD, BARBIE ANN (LE)
Entity type:Individual
Prefix:
First Name:BARBIE
Middle Name:ANN
Last Name:WOODWARD
Suffix:
Gender:F
Credentials:LE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:384 JACKSON ST STE 3&4
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94544-1547
Mailing Address - Country:US
Mailing Address - Phone:408-680-9313
Mailing Address - Fax:
Practice Address - Street 1:384 JACKSON ST STE 4
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94544-1556
Practice Address - Country:US
Practice Address - Phone:510-500-6769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-14
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL9861174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty