Basic Information
| Provider Information | |||||||||
| NPI: | 1063649523 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WOOD | ||||||||
| FirstName: | JACLYN | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 944 W WINDSOR DR | ||||||||
| Address2: | |||||||||
| City: | HANFORD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932306792 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7244335134 | ||||||||
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| Practice Location | |||||||||
| Address1: | 115 MALL DR | ||||||||
| Address2: | |||||||||
| City: | HANFORD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932305786 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5595370550 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2009 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207PE0004X | 14772 | NV | N | Allopathic & Osteopathic Physicians | Emergency Medicine | Emergency Medical Services | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207P00000X | A139450 | CA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.