Healthcare Provider Details

I. General information

NPI: 1740165679
Provider Name (Legal Business Name): MS WOUND CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2025
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2247 E MALLORY CIR
MESA AZ
85213-1413
US

IV. Provider business mailing address

19 CHAPITAL
SAN CLEMENTE CA
92672-9311
US

V. Phone/Fax

Practice location:
  • Phone: 949-627-3272
  • Fax: 949-499-9877
Mailing address:
  • Phone: 949-627-3272
  • Fax: 949-499-9877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MARCUS YETTER
Title or Position: OWNER
Credential: DPM
Phone: 480-390-8436