Healthcare Provider Details

I. General information

NPI: 1588472989
Provider Name (Legal Business Name): ALTIUS WOUND SOLUTIONS MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2024
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 E COLORADO BLVD FL 5
PASADENA CA
91106-2327
US

IV. Provider business mailing address

1055 E COLORADO BLVD FL 5
PASADENA CA
91106-2327
US

V. Phone/Fax

Practice location:
  • Phone: 213-852-3357
  • Fax:
Mailing address:
  • Phone: 213-852-3357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL SILAO
Title or Position: CEO
Credential: MD
Phone: 213-852-3357