Healthcare Provider Details

I. General information

NPI: 1649885096
Provider Name (Legal Business Name): WOUND PROS UTAH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2020
Last Update Date: 01/09/2023
Certification Date: 01/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 W 5300 S STE 525
MURRAY UT
84123-5682
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 323-545-4031
  • Fax:
Mailing address:
  • Phone: 323-480-4075
  • Fax: 323-433-9177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. CHRISTOPHER AYODELE OTIKO
Title or Position: PRESIDENT
Credential: DPM
Phone: 818-836-2475