| Doctor Name: | SAMUEL WOOD |
| NPI Number: | 1003277856 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 95071479 |
| Business Practice Address: | 803 Grove Ave Imperial Beach, CA - 91932 |
| Business Phone Number: | 5174149304 |
| Business Fax Number: | |
| Mailing Address: | 803 Grove Ave, IMPERIAL BEACH |
| State: | CA |
| Postal Code: | 91932 |
| Phone Number: | 5174149304 |
| Fax Number: | |
| NPI Enumeration Date: | 03/08/2016 |
| NPI Last Update Date: | 03/08/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WP0809X |
| License Number: | 95071479 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Psych/Mental Health, Adult |
| Taxonomy Definition: | |