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General NPI Number Information
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NPI Number | 1356238158
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Entity Type | Organization
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Legal Business Name | ALLIANCE WOUND SPECIALIST
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Dates
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Enumeration Date | 06/23/2025
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Last Update Date | 06/23/2025
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Provider Practice Location Address
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Address Line | 15315 MAGNOLIA BLVD STE 102
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City | SHERMAN OAKS
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State | CA
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Zip | 91403-1100
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Country | US
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Telephone | 510-329-3240
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Fax |
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Provider Business Mailing Address
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Address Line | 15315 MAGNOLIA BLVD STE 102
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City | SHERMAN OAKS
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State | CA
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Zip | 91403-1100
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Country | US
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Telephone | 510-329-3240
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. CLEM DULCE RODRIGUEZ
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Credential | MD
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Telephone | 510-329-3240
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State | NULL
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Taxonomy #2
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Taxonomy Code | 163WW0000X
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Taxonomy Name | Wound Care Registered Nurse
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License Number |
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License Number State | NULL
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