Healthcare Provider Details

I. General information

NPI: 1942036520
Provider Name (Legal Business Name): WOUND HEALTH MEDICAL CA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2024
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11845 W OLYMPIC BLVD STE 1100
LOS ANGELES CA
90064-1149
US

IV. Provider business mailing address

11845 W OLYMPIC BLVD STE 1100
LOS ANGELES CA
90064-1149
US

V. Phone/Fax

Practice location:
  • Phone: 310-560-1575
  • Fax: 153-107-3417
Mailing address:
  • Phone: 310-560-1575
  • Fax: 153-107-3417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: TERI NOEL BILHARTZ
Title or Position: MEDICAL DIRECTOR
Credential:
Phone: 804-464-8417