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General NPI Number Information
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NPI Number | 1063394716
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Entity Type | Organization
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Legal Business Name | PROFOUND WOUND SPECIALISTS INC
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Dates
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Enumeration Date | 07/23/2025
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Last Update Date | 07/23/2025
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Provider Practice Location Address
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Address Line | 11145 TAMPA AVE STE 27A
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City | PORTER RANCH
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State | CA
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Zip | 91326-2274
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Country | US
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Telephone | 818-717-7181
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Fax |
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Provider Business Mailing Address
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Address Line | 11145 TAMPA AVE STE 27A
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City | PORTER RANCH
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State | CA
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Zip | 91326-2274
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Country | US
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Telephone | 818-717-7181
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ANDRANIK GEVORKYAN
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Credential |
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Telephone | 310-885-9888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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