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General NPI Number Information
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NPI Number | 1083426274
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Entity Type | Organization
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Legal Business Name | WOUND CARE CENTER OF SOCAL PC
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Dates
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Enumeration Date | 01/23/2025
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Last Update Date | 01/31/2025
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Provider Practice Location Address
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Address Line | 984 W FOOTHILL BLVD STE A
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City | UPLAND
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State | CA
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Zip | 91786-3700
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Country | US
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Telephone | 909-920-0884
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Fax | 909-920-9810
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Provider Business Mailing Address
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Address Line | 984 W FOOTHILL BLVD STE A
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City | UPLAND
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State | CA
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Zip | 91786-3700
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Country | US
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Telephone | 909-920-0884
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Fax | 909-920-9810
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Authorized Official
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Title or Position | BILLER
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Name | ROBERTA LEE
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Credential |
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Telephone | 323-543-4303
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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