Healthcare Provider Details

I. General information

NPI: 1356238158
Provider Name (Legal Business Name): ALLIANCE WOUND SPECIALIST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2025
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15315 MAGNOLIA BLVD STE 102
SHERMAN OAKS CA
91403-1100
US

IV. Provider business mailing address

15315 MAGNOLIA BLVD STE 102
SHERMAN OAKS CA
91403-1100
US

V. Phone/Fax

Practice location:
  • Phone: 510-329-3240
  • Fax:
Mailing address:
  • Phone: 510-329-3240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. CLEM DULCE RODRIGUEZ
Title or Position: DIRECTOR
Credential: MD
Phone: 510-329-3240