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General NPI Number Information
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NPI Number | 1578219630
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Entity Type | Organization
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Legal Business Name | ADVANCED HOME WOUND CARE INC.
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Dates
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Enumeration Date | 02/28/2022
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Last Update Date | 02/28/2022
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Provider Practice Location Address
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Address Line | 4223 YACHT HARBOR DR
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City | STOCKTON
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State | CA
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Zip | 95204-1123
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Country | US
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Telephone | 310-944-1912
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Fax |
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Provider Business Mailing Address
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Address Line | 4223 YACHT HARBOR DR
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City | STOCKTON
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State | CA
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Zip | 95204-1123
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Country | US
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Telephone |
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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. JOSHUA BOYD STAUFFER
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Credential | DPM
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Telephone | 310-944-1912
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP1100X
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Taxonomy Name | Podiatric 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 | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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