Healthcare Provider Details

I. General information

NPI: 1083568638
Provider Name (Legal Business Name): IMPERIAL VASCULAR WOUND CARE SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2026
Last Update Date: 02/23/2026
Certification Date: 02/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 W STATE ST
EL CENTRO CA
92243-3021
US

IV. Provider business mailing address

18092 WIKA RD STE 220
APPLE VALLEY CA
92307-2132
US

V. Phone/Fax

Practice location:
  • Phone: 760-683-2199
  • Fax:
Mailing address:
  • Phone: 760-515-6260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: OMAR TAHIR
Title or Position: PRESIDENT
Credential: MD
Phone: 760-515-6260