Healthcare Provider Details

I. General information

NPI: 1578441242
Provider Name (Legal Business Name): PRIME WOUND SOLUTIONS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2025
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1421 E COOLEY DR STE 9
COLTON CA
92324-3979
US

IV. Provider business mailing address

1421 E COOLEY DR STE 9
COLTON CA
92324-3979
US

V. Phone/Fax

Practice location:
  • Phone: 909-377-1171
  • Fax:
Mailing address:
  • Phone:
  • 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 Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JEMAR LINSANGAN
Title or Position: OWNER
Credential:
Phone: 909-377-1171