Provider Demographics
NPI:1255971784
Name:WOODS, RHONDA DARSELLE (MED)
Entity type:Individual
Prefix:
First Name:RHONDA
Middle Name:DARSELLE
Last Name:WOODS
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1474 AUTUMN LEAVES TRL
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75241-1213
Mailing Address - Country:US
Mailing Address - Phone:214-729-3459
Mailing Address - Fax:
Practice Address - Street 1:1474 AUTUMN LEAVES TRL
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75241-1213
Practice Address - Country:US
Practice Address - Phone:214-729-3459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-13
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX08359582172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver