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General NPI Number Information
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NPI Number | 1609762285
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Entity Type | Organization
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Legal Business Name | WELLO WOUND CARE, LLC
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Dates
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Enumeration Date | 06/17/2025
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Last Update Date | 06/17/2025
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Provider Practice Location Address
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Address Line | 11239 VENTURA BLVD STE 212, UNIT 2
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City | STUDIO CITY
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State | CA
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Zip | 91604
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Country | US
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Telephone | 224-425-1142
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Fax |
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Provider Business Mailing Address
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Address Line | 11413 ETIWANDA AVE
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City | PORTER RANCH
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State | CA
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Zip | 91326-2013
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Country | US
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Telephone | 224-425-1142
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Fax |
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Authorized Official
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Title or Position | PRINCIPAL PROVIDER AND LEADER
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Name | ROVIN SANTOS
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Credential | NP
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Telephone | 224-425-1142
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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 |
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Taxonomy #2
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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