Healthcare Provider Details

I. General information

NPI: 1457284408
Provider Name (Legal Business Name): CRESCENT WOUND CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2045 SILVERADA BLVD
RENO NV
89512-2051
US

IV. Provider business mailing address

5580 LA JOLLA BLVD STE 622
LA JOLLA CA
92037-7651
US

V. Phone/Fax

Practice location:
  • Phone: 775-359-3161
  • Fax: 775-331-2878
Mailing address:
  • Phone: 858-221-7726
  • Fax: 858-431-4736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MOHAMED KADRY-HASSANEIN
Title or Position: OWNER
Credential: MD
Phone: 858-967-3070