Healthcare Provider Details

I. General information

NPI: 1447401377
Provider Name (Legal Business Name): CALIFORNIA WOUND CARE INSTITUTE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2008
Last Update Date: 02/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9098 LAGUNA MAIN ST SUITE 6
ELK GROVE CA
95758-7449
US

IV. Provider business mailing address

9098 LAGUNA MAIN ST SUITE 6
ELK GROVE CA
95758-7449
US

V. Phone/Fax

Practice location:
  • Phone: 916-691-6780
  • Fax:
Mailing address:
  • Phone: 916-691-6780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: OTASHE GOLDEN
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 916-691-6780