Healthcare Provider Details

I. General information

NPI: 1881417889
Provider Name (Legal Business Name): AMERICAN WOUND CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2024
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14349 VICTORY BLVD STE 200
VAN NUYS CA
91401-6515
US

IV. Provider business mailing address

14349 VICTORY BLVD STE 200
VAN NUYS CA
91401-6515
US

V. Phone/Fax

Practice location:
  • Phone: 917-732-6379
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: OREN RAPHAEL
Title or Position: OWNER
Credential: MD
Phone: 917-732-6379