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General NPI Number Information
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NPI Number | 1396548236
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Entity Type | Organization
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Legal Business Name | WOUND HEALING CARE CENTER PC
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Dates
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Enumeration Date | 03/27/2025
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Last Update Date | 03/27/2025
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Provider Practice Location Address
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Address Line | 11343 BASE LINE RD
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-7273
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Country | US
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Telephone | 909-944-0486
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Fax | 909-944-3161
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Provider Business Mailing Address
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Address Line | 25044 PEACHLAND AVE STE 110
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City | NEWHALL
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State | CA
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Zip | 91321-5730
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Country | US
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Telephone | 909-944-0486
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | PETE CARRASCO
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Credential | DPM
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Telephone | 909-944-0486
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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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 #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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