Healthcare Provider Details

I. General information

NPI: 1588557524
Provider Name (Legal Business Name): PRECISION WOUND CLINICIANS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2025
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18064 WIKA RD STE 103
APPLE VALLEY CA
92307-2182
US

IV. Provider business mailing address

18064 WIKA RD STE 103
APPLE VALLEY CA
92307-2182
US

V. Phone/Fax

Practice location:
  • Phone: 951-500-3801
  • Fax:
Mailing address:
  • Phone: 951-500-3801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LLOYDETTE BREWAH
Title or Position: PRACTICE OWNER
Credential:
Phone: 951-500-3801