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General NPI Number Information
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NPI Number | 1467633149
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Entity Type | Organization
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Legal Business Name | MAHONING VALLEY WOUND CARE, INC.
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Dates
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Enumeration Date | 11/21/2007
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Last Update Date | 01/26/2012
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Provider Practice Location Address
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Address Line | 540 PARMALEE AVE SUITE 610
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City | YOUNGSTOWN
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State | OH
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Zip | 44510-1716
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Country | US
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Telephone | 330-480-2078
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Fax |
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Provider Business Mailing Address
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Address Line | 540 PARMALEE AVE SUITE 610
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City | YOUNGSTOWN
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State | OH
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Zip | 44510-1716
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Country | US
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Telephone | 330-480-2078
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. FELIX A PESA
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Credential |
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Telephone | 330-480-2078
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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 | 34025917
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License Number State | OH
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