Healthcare Provider Details

I. General information

NPI: 1275368219
Provider Name (Legal Business Name): PINNACLE WOUND CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2024
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

934 RIO LINDO
SAN CLEMENTE CA
92672-7200
US

IV. Provider business mailing address

934 RIO LINDO
SAN CLEMENTE CA
92672-7200
US

V. Phone/Fax

Practice location:
  • Phone: 480-766-3866
  • Fax:
Mailing address:
  • Phone: 480-766-3866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MARCUS YETTER
Title or Position: CO-OWNER
Credential: DPM
Phone: 480-390-8436