Healthcare Provider Details

I. General information

NPI: 1144159906
Provider Name (Legal Business Name): KORBYN WESLEY POUNDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24914 RAINBARREL RD
WILDOMAR CA
92595-7668
US

IV. Provider business mailing address

24914 RAINBARREL RD
WILDOMAR CA
92595-7668
US

V. Phone/Fax

Practice location:
  • Phone: 951-226-4635
  • Fax:
Mailing address:
  • Phone: 951-226-4635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: