Provider Demographics
NPI:1215663844
Name:STEPHANIE WOODWARD MD INC
Entity type:Organization
Organization Name:STEPHANIE WOODWARD MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODWARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-371-4589
Mailing Address - Street 1:1671 W MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-5420
Mailing Address - Country:US
Mailing Address - Phone:760-353-2244
Mailing Address - Fax:
Practice Address - Street 1:1671 W MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-5420
Practice Address - Country:US
Practice Address - Phone:760-353-2244
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-26
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty