| Organization Name: | WOODMAN MEDICAL CARE AND CLINIC |
| NPI Number: | 1205196094 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JAMES A HARTLEROAD (OWNER) |
| Mailing Address: | 13653 Victory Blvd Van Nuys |
| State: | CA US |
| Postal Code: | 914011735 |
| Phone Number: | 8189889825 |
| Fax Number: | |
| NPI Enumeration Date: | 05/25/2012 |
| NPI Last Update Date: | 05/25/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 00G749010 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |