=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386439651
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WOUNDSAFE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/09/2025
-----------------------------------------------------
Last Update Date | 04/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15720 VENTURA BLVD STE 305
-----------------------------------------------------
City | ENCINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91436-2988
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-290-3038
-----------------------------------------------------
Fax | 818-290-3102
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15720 VENTURA BLVD STE 305
-----------------------------------------------------
City | ENCINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91436-2988
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-290-3038
-----------------------------------------------------
Fax | 818-290-3102
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SECRETARY
-----------------------------------------------------
Name | MARINE VARDANYAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 818-572-3937
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------