Healthcare Provider Details

I. General information

NPI: 1639985401
Provider Name (Legal Business Name): HLMG WOUND CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2024
Last Update Date: 12/06/2024
Certification Date: 12/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 ARDEN AVE STE 101
GLENDALE CA
91203-1110
US

IV. Provider business mailing address

350 ARDEN AVE STE 101
GLENDALE CA
91203-1110
US

V. Phone/Fax

Practice location:
  • Phone: 818-906-4466
  • Fax:
Mailing address:
  • Phone: 818-906-4466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: BRIANNE CRYSTAL GOBER
Title or Position: CEO/OWNER
Credential: MD
Phone: 818-906-4466