Healthcare Provider Details

I. General information

NPI: 1669603296
Provider Name (Legal Business Name): ADVANCED WOUND AND SURGICAL MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2009
Last Update Date: 04/01/2020
Certification Date: 04/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 SILLECT AVE SUITE 201
BAKERSFIELD CA
93308-6371
US

IV. Provider business mailing address

2901 SILLECT AVE SUITE 201
BAKERSFIELD CA
93308-6371
US

V. Phone/Fax

Practice location:
  • Phone: 661-327-2101
  • Fax: 661-327-2554
Mailing address:
  • Phone: 661-327-2101
  • Fax: 661-327-2554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License NumberA63639
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. VIPUL RAMAN DEV
Title or Position: CEO
Credential: MD
Phone: 661-327-2101