Healthcare Provider Details

I. General information

NPI: 1396548236
Provider Name (Legal Business Name): WOUND HEALING CARE CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2025
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11343 BASE LINE RD
RANCHO CUCAMONGA CA
91730-7273
US

IV. Provider business mailing address

25044 PEACHLAND AVE STE 110
NEWHALL CA
91321-5730
US

V. Phone/Fax

Practice location:
  • Phone: 909-944-0486
  • Fax: 909-944-3161
Mailing address:
  • Phone: 909-944-0486
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: PETE CARRASCO
Title or Position: CEO
Credential: DPM
Phone: 909-944-0486