Healthcare Provider Details

I. General information

NPI: 1891333449
Provider Name (Legal Business Name): WOUND PROS FLORIDA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2019
Last Update Date: 02/02/2023
Certification Date: 02/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4728 N HABANA AVE STE 203
TAMPA FL
33614-7147
US

IV. Provider business mailing address

5901 W CENTURY BLVD STE 750
LOS ANGELES CA
90045-5443
US

V. Phone/Fax

Practice location:
  • Phone: 323-315-0491
  • Fax:
Mailing address:
  • Phone: 323-480-4075
  • Fax: 818-572-0858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. CHRISTOPHER AYODELE OTIKO
Title or Position: PRESIDENT
Credential: DPM
Phone: 818-708-7668