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General NPI Number Information
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NPI Number | 1083568638
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Entity Type | Organization
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Legal Business Name | IMPERIAL VASCULAR WOUND CARE SPECIALISTS
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Dates
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Enumeration Date | 02/23/2026
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Last Update Date | 02/23/2026
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Provider Practice Location Address
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Address Line | 441 W STATE ST
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City | EL CENTRO
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State | CA
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Zip | 92243-3021
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Country | US
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Telephone | 760-683-2199
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Fax |
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Provider Business Mailing Address
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Address Line | 18092 WIKA RD STE 220
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City | APPLE VALLEY
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State | CA
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Zip | 92307-2132
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Country | US
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Telephone | 760-515-6260
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | OMAR TAHIR
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Credential | MD
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Telephone | 760-515-6260
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number |
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License Number State |
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