Healthcare Provider Details

I. General information

NPI: 1437505393
Provider Name (Legal Business Name): WOUND INSTITUTE OF AMERICA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2016
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 N ROBERTSON BLVD STE 104A
BEVERLY HILLS CA
90211-1794
US

IV. Provider business mailing address

9663 SANTA MONICA BLVD # 1151
BEVERLY HILLS CA
90210-4303
US

V. Phone/Fax

Practice location:
  • Phone: 310-919-4179
  • Fax: 877-239-0944
Mailing address:
  • Phone: 310-919-4179
  • Fax: 877-239-0944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number StateCA

VIII. Authorized Official

Name: NICOLE GARRETT
Title or Position: COO
Credential:
Phone: 310-919-4179