Provider Demographics
NPI:1053435099
Name:WOODWARD, STEPHANIE MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:MARIE
Last Name:WOODWARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7910 FROST ST
Mailing Address - Street 2:SUITE 450
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-2771
Mailing Address - Country:US
Mailing Address - Phone:858-565-0104
Mailing Address - Fax:858-565-0194
Practice Address - Street 1:7910 FROST ST
Practice Address - Street 2:SUITE 450
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-2771
Practice Address - Country:US
Practice Address - Phone:858-565-0104
Practice Address - Fax:858-565-0194
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA103828208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA103828OtherMEDICAL LICENSE
NVLL1680OtherMEDICAL LICENSE
NVLL1680OtherMEDICAL LICENSE