Provider Demographics
NPI:1720896814
Name:WOOD, ASHLEY L (RD)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:L
Last Name:WOOD
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:L
Other - Last Name:LUCAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:36695 STRAIGHTAWAY DR
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:CA
Mailing Address - Zip Code:92223-8150
Mailing Address - Country:US
Mailing Address - Phone:951-537-8118
Mailing Address - Fax:
Practice Address - Street 1:36695 STRAIGHTAWAY DR
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:CA
Practice Address - Zip Code:92223-8150
Practice Address - Country:US
Practice Address - Phone:951-537-8118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-21
Last Update Date:2024-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1067410133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered