Healthcare Provider Details

I. General information

NPI: 1083536015
Provider Name (Legal Business Name): SANTA MONICA WOUND CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 COLORADO AVE STE 100E
SANTA MONICA CA
90404-5535
US

IV. Provider business mailing address

2450 COLORADO AVE STE 100E
SANTA MONICA CA
90404-5535
US

V. Phone/Fax

Practice location:
  • Phone: 213-676-1551
  • Fax:
Mailing address:
  • Phone: 213-676-1551
  • 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: FIRDAVS BURIEV
Title or Position: CEO
Credential:
Phone: 213-676-1551