Healthcare Provider Details

I. General information

NPI: 1588471809
Provider Name (Legal Business Name): MOBILE WOUND CARE SPECIALIST LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2024
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13832 N 32ND ST STE C124126G
PHOENIX AZ
85032-5613
US

IV. Provider business mailing address

13832 N 32ND ST STE C124126G
PHOENIX AZ
85032-5613
US

V. Phone/Fax

Practice location:
  • Phone: 480-234-3568
  • Fax: 602-374-3643
Mailing address:
  • Phone: 480-234-3568
  • Fax: 602-374-3643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: GERALDINE GRIFFITHS
Title or Position: MANAGER
Credential:
Phone: 480-329-6085