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General NPI Number Information
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NPI Number | 1043977184
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Entity Type | Organization
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Legal Business Name | THE WOUND CARE DOCTORS
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Dates
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Enumeration Date | 11/23/2021
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Last Update Date | 04/01/2022
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Provider Practice Location Address
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Address Line | 8608 UTICA AVE STE 218
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-4879
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Country | US
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Telephone | 626-569-0088
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Fax | 866-443-7567
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Provider Business Mailing Address
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Address Line | 25044 PEACHLAND AVE STE 110
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City | NEWHALL
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State | CA
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Zip | 91321-5730
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Country | US
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Telephone | 818-636-6749
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Fax |
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Authorized Official
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Title or Position | PRESIDENT&CEO
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Name | BO LIU
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Credential | MD
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Telephone | 626-569-0088
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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