Healthcare Provider Details

I. General information

NPI: 1164035101
Provider Name (Legal Business Name): TURLOCK WOUND CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2020
Last Update Date: 10/15/2021
Certification Date: 10/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 COLORADO AVE
TURLOCK CA
95382-2003
US

IV. Provider business mailing address

2150 COLORADO AVE
TURLOCK CA
95382-2003
US

V. Phone/Fax

Practice location:
  • Phone: 209-656-0183
  • Fax:
Mailing address:
  • Phone: 209-656-0183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: HUY NGOC DAO
Title or Position: OWNER
Credential: MD
Phone: 209-656-0183