Healthcare Provider Details

I. General information

NPI: 1730675158
Provider Name (Legal Business Name): MOBILE WOUND CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2018
Last Update Date: 07/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 AVENIDA PICO # C488
SAN CLEMENTE CA
92673-6957
US

IV. Provider business mailing address

1001 AVENIDA PICO # C488
SAN CLEMENTE CA
92673-6957
US

V. Phone/Fax

Practice location:
  • Phone: 949-226-8400
  • Fax:
Mailing address:
  • Phone: 949-226-8400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL HAGA
Title or Position: CEO
Credential: MD
Phone: 949-226-8416