Healthcare Provider Details

I. General information

NPI: 1801679147
Provider Name (Legal Business Name): IMANI WOUNDCARE SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2023
Last Update Date: 08/18/2023
Certification Date: 08/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27555 YNEZ RD STE 210
TEMECULA CA
92591-4678
US

IV. Provider business mailing address

27555 YNEZ RD STE 210
TEMECULA CA
92591-4678
US

V. Phone/Fax

Practice location:
  • Phone: 909-614-3039
  • Fax:
Mailing address:
  • Phone: 909-614-3039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: EMMA JACKSON
Title or Position: AUTHORIZED OFFICIAL
Credential: NP
Phone: 909-614-3039