Healthcare Provider Details

I. General information

NPI: 1013731009
Provider Name (Legal Business Name): ADVANCED MOBILE WOUND CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2024
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15130 VENTURA BLVD STE 324
SHERMAN OAKS CA
91403-3378
US

IV. Provider business mailing address

15130 VENTURA BLVD STE 324
SHERMAN OAKS CA
91403-3378
US

V. Phone/Fax

Practice location:
  • Phone: 818-726-5686
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MAGDEN MAGGIE AMIRIAN
Title or Position: OWNER
Credential:
Phone: 818-726-5686