Healthcare Provider Details

I. General information

NPI: 1144167321
Provider Name (Legal Business Name): WOUND HEALING CARE SPECIALISTS UT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2819 S 5600 W
WEST VALLEY CITY UT
84120-4605
US

IV. Provider business mailing address

3536 CONCOURS STE 225
ONTARIO CA
91764-5585
US

V. Phone/Fax

Practice location:
  • Phone: 909-944-0486
  • Fax: 909-944-3161
Mailing address:
  • Phone: 909-944-0486
  • Fax: 909-944-3161

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
Title or Position: PRESIDENT & CEO
Credential: DPM
Phone: 909-944-0486