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General NPI Number Information
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NPI Number | 1144119629
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Entity Type | Organization
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Legal Business Name | ADVANCED MOBILE WOUND HEALING PHYSICIAN ASSISTANT, PC
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Dates
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Enumeration Date | 06/30/2025
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Last Update Date | 06/30/2025
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Provider Practice Location Address
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Address Line | 2108 N ST STE N
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City | SACRAMENTO
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State | CA
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Zip | 95816-5712
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Country | US
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Telephone | 509-768-2249
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Fax |
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Provider Business Mailing Address
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Address Line | 2108 N ST STE N
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City | SACRAMENTO
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State | CA
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Zip | 95816-5712
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Country | US
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Telephone | 509-768-2249
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN ASSISTANT
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Name | CHIBUIKEM K OKORO
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Credential | PA-C
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Telephone | 336-587-2367
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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