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General NPI Number Information
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NPI Number | 1629861844
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Entity Type | Organization
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Legal Business Name | ADVANCE WOUND CARE PROS
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Dates
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Enumeration Date | 05/28/2025
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Last Update Date | 05/28/2025
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Provider Practice Location Address
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Address Line | 6257 VAN NUYS BLVD STE A
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City | VAN NUYS
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State | CA
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Zip | 91401-2733
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Country | US
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Telephone | 818-939-6289
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Fax |
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Provider Business Mailing Address
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Address Line | 6257 VAN NUYS BLVD STE A
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City | VAN NUYS
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State | CA
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Zip | 91401-2733
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Country | US
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Telephone | 818-939-6289
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | GEVORK EKIMYAN
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Credential |
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Telephone | 818-939-6289
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0000X
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Taxonomy Name | Adolescent Medicine (Family Medicine) 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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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