Healthcare Provider Details

I. General information

NPI: 1114854023
Provider Name (Legal Business Name): GROSSMAN BURN AND WOUND ALLIANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7325 MEDICAL CENTER DR STE 200
WEST HILLS CA
91307-1938
US

IV. Provider business mailing address

5060 CALIFORNIA AVE STE 310
BAKERSFIELD CA
93309-7051
US

V. Phone/Fax

Practice location:
  • Phone: 818-439-6301
  • Fax:
Mailing address:
  • Phone: 661-869-2600
  • Fax: 661-869-2003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. BRANDY SPARKS
Title or Position: BILLING ADMIN
Credential:
Phone: 661-869-2600