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General NPI Number Information
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NPI Number | 1053107854
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Entity Type | Organization
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Legal Business Name | REGIONAL WOUND CARE
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Dates
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Enumeration Date | 04/17/2025
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Last Update Date | 09/03/2025
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Provider Practice Location Address
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Address Line | 6308 WOODMAN AVE STE 101
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City | VAN NUYS
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State | CA
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Zip | 91401-2367
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Country | US
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Telephone | 619-252-1210
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Fax |
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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 |
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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 | ALFRED CISNEROS
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Credential | MD
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Telephone | 661-649-4713
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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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