Healthcare Provider Details

I. General information

NPI: 1295583250
Provider Name (Legal Business Name): WOUND RESCUE SPECIALIST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2024
Last Update Date: 05/07/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 W HOSPITALITY LN STE 317
SAN BERNARDINO CA
92408-3265
US

IV. Provider business mailing address

275 W HOSPITALITY LN STE 317
SAN BERNARDINO CA
92408-3265
US

V. Phone/Fax

Practice location:
  • Phone: 909-763-3363
  • Fax: 909-769-0109
Mailing address:
  • Phone: 909-763-3363
  • Fax: 909-769-0109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: BEHROZ HAMKAR
Title or Position: OWNER
Credential: MD
Phone: 909-763-3363