Healthcare Provider Details

I. General information

NPI: 1881539971
Provider Name (Legal Business Name): WOUND HEALING CARE SPECIALISTS ID, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1014 BURRELL AVE
LEWISTON ID
83501-5472
US

IV. Provider business mailing address

3295 W ELDER ST STE 209
BOISE ID
83705-4772
US

V. Phone/Fax

Practice location:
  • Phone: 909-944-0486
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: PETE CARRASCO JR.
Title or Position: OWNER
Credential: DPM
Phone: 909-944-0486