Healthcare Provider Details

I. General information

NPI: 1104622554
Provider Name (Legal Business Name): RIVELLO WOUND CARE SPECIALISTS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2025
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6737 W WREN AVE
VISALIA CA
93291-8344
US

IV. Provider business mailing address

6737 W WREN AVE
VISALIA CA
93291-8344
US

V. Phone/Fax

Practice location:
  • Phone: 760-542-6615
  • Fax:
Mailing address:
  • Phone: 760-542-6615
  • 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 Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: MISS HAZEL LLOCE
Title or Position: PRACTICE MANAGER
Credential:
Phone: 760-542-6615