Healthcare Provider Details

I. General information

NPI: 1255860136
Provider Name (Legal Business Name): XIMED WOUND CARE CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2017
Last Update Date: 06/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9850 GENESEE AVE STE 360
LA JOLLA CA
92037-1212
US

IV. Provider business mailing address

9850 GENESEE AVE STE 900
LA JOLLA CA
92037-1220
US

V. Phone/Fax

Practice location:
  • Phone: 858-452-1279
  • Fax: 858-452-1279
Mailing address:
  • Phone: 858-452-1279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: THOMAS C. SOUNHEIN
Title or Position: CEO
Credential:
Phone: 858-452-1279