Basic Information
| Provider Information | |||||||||
| NPI: | 1952572976 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WOOD | ||||||||
| FirstName: | ANA | ||||||||
| MiddleName: | LETICIA | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | R.N., P.H.N. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7401 LIBERTY AVE | ||||||||
| Address2: | |||||||||
| City: | CORONA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928814887 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9512782539 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1725 W 17TH ST | ||||||||
| Address2: | |||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927062316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7148347763 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/18/2008 | ||||||||
| LastUpdateDate: | 03/18/2008 | ||||||||
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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 | 163WC0400X | 268127 | CA | N | Nursing Service Providers | Registered Nurse | Case Management | 163WC1500X | PHN#36677 | CA | Y | Nursing Service Providers | Registered Nurse | Community Health |
ID Information
| ID | Type | State | Issuer | Description | 163WCI500X | 01 | CA | PUBLIC HEALTH NURSE | OTHER |