Healthcare Provider Details

I. General information

NPI: 1235831132
Provider Name (Legal Business Name): GLOBAL WOUND CARE MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2023
Last Update Date: 01/26/2024
Certification Date: 01/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 W CENTURY BLVD STE 750
LOS ANGELES CA
90045-5443
US

IV. Provider business mailing address

5901 W CENTURY BLVD STE 750
LOS ANGELES CA
90045-5443
US

V. Phone/Fax

Practice location:
  • Phone: 323-480-4075
  • Fax:
Mailing address:
  • Phone: 323-480-4075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. OWEN BERNARDO ELLINGTON
Title or Position: PRESIDENT
Credential: MD
Phone: 713-304-4227