Healthcare Provider Details

I. General information

NPI: 1508566035
Provider Name (Legal Business Name): UNIVERSAL WOUND MANAGEMENT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2023
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3390 UNIVERSITY AVE STE 640
RIVERSIDE CA
92501-3314
US

IV. Provider business mailing address

3390 UNIVERSITY AVE STE 640 SUITE 640
RIVERSIDE CA
92501-3314
US

V. Phone/Fax

Practice location:
  • Phone: 302-200-9686
  • Fax: 951-742-5135
Mailing address:
  • Phone: 302-200-9686
  • Fax: 951-742-5135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. A J ROGERS
Title or Position: CEO
Credential: MD
Phone: 302-200-9698