Healthcare Provider Details

I. General information

NPI: 1891687638
Provider Name (Legal Business Name): PACIFIC WOUND CARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2025
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 1/2 S MYRTLE AVE
MONROVIA CA
91016-5100
US

IV. Provider business mailing address

5050 PALO VERDE ST STE 212
MONTCLAIR CA
91763-2334
US

V. Phone/Fax

Practice location:
  • Phone: 909-569-4561
  • Fax: 406-586-8494
Mailing address:
  • Phone: 909-569-4561
  • Fax: 406-586-8494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: ABID RIZVI
Title or Position: OWNER
Credential: MD FACP
Phone: 909-542-2777