Healthcare Provider Details

I. General information

NPI: 1205671773
Provider Name (Legal Business Name): WOUND AWAY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2024
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14525 VALLEY VIEW AVE STE E
SANTA FE SPRINGS CA
90670-5237
US

IV. Provider business mailing address

14525 VALLEY VIEW AVE STE E
SANTA FE SPRINGS CA
90670-5237
US

V. Phone/Fax

Practice location:
  • Phone: 714-457-9905
  • Fax:
Mailing address:
  • Phone: 714-457-9905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. JESSICA CAROL-MACIAS WONG
Title or Position: PRESIDENT
Credential:
Phone: 714-457-9905