Healthcare Provider Details

I. General information

NPI: 1891674446
Provider Name (Legal Business Name): PREMIER WOUND MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2025
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 N BRAND BLVD STE L103E
GLENDALE CA
91203-4459
US

IV. Provider business mailing address

401 N BRAND BLVD STE L103E
GLENDALE CA
91203-4459
US

V. Phone/Fax

Practice location:
  • Phone: 818-730-5352
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: VILIK HARUTUNYAN
Title or Position: CEO
Credential: REGISTERED NURSE
Phone: 818-730-5352