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General NPI Number Information
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NPI Number | 1063109668
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Entity Type | Organization
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Legal Business Name | SPECIALTY WOUND HEALING AND RECONSTRUCTION INC
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Dates
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Enumeration Date | 04/24/2023
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Last Update Date | 03/21/2025
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Provider Practice Location Address
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Address Line | 50 BELLEFONTAINE ST STE 304
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City | PASADENA
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State | CA
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Zip | 91105-3132
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Country | US
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Telephone | 626-325-8246
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Fax |
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Provider Business Mailing Address
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Address Line | 50 BELLEFONTAINE ST STE 304
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City | PASADENA
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State | CA
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Zip | 91105-3132
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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
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Name | DR. SANJEEV PURI
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Credential | MD
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Telephone | 626-325-8246
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number |
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License Number State |
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