Healthcare Provider Details

I. General information

NPI: 1114885522
Provider Name (Legal Business Name): WOUND HEALING RECOVERY CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2026
Last Update Date: 01/13/2026
Certification Date: 01/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 W HOSPITALITY LN STE 303
SAN BERNARDINO CA
92408-3221
US

IV. Provider business mailing address

225 W HOSPITALITY LN STE 303
SAN BERNARDINO CA
92408-3221
US

V. Phone/Fax

Practice location:
  • Phone: 562-780-1669
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2081P0004X
TaxonomySpinal Cord Injury Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: RAYA TABLANG
Title or Position: OWNER
Credential: MD
Phone: 562-780-1669