Healthcare Provider Details

I. General information

NPI: 1750172995
Provider Name (Legal Business Name): WOUND HAVEN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2025
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 FOOTHILL BLVD STE 104
LA CRESCENTA CA
91214-4578
US

IV. Provider business mailing address

2600 FOOTHILL BLVD STE 104
LA CRESCENTA CA
91214-4578
US

V. Phone/Fax

Practice location:
  • Phone: 818-331-2685
  • Fax:
Mailing address:
  • Phone: 818-331-2685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: HOVSEP ZEYTUNYAN
Title or Position: PRACTICE OWNER
Credential:
Phone: 818-331-2685