Healthcare Provider Details

I. General information

NPI: 1194517482
Provider Name (Legal Business Name): INNOVATIVE WOUND SOLUTIONS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2025
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44045 MARGARITA RD STE 101
TEMECULA CA
92592-2729
US

IV. Provider business mailing address

44045 MARGARITA RD STE 101
TEMECULA CA
92592-2729
US

V. Phone/Fax

Practice location:
  • Phone: 951-880-0701
  • Fax:
Mailing address:
  • Phone: 951-880-0701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: RICHARD JIN
Title or Position: PARTNER
Credential: MD
Phone: 949-244-2434