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General NPI Number Information
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NPI Number | 1720475148
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Entity Type | Organization
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Legal Business Name | ADVANCED WOUND CARE, INC
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Dates
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Enumeration Date | 04/23/2015
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Last Update Date | 04/23/2015
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Provider Practice Location Address
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Address Line | 5124 BLOCH ST
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City | SAN DIEGO
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State | CA
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Zip | 92122-4005
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Country | US
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Telephone | 619-461-1898
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Fax |
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Provider Business Mailing Address
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Address Line | 5124 BLOCH ST
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City | SAN DIEGO
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State | CA
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Zip | 92122-4005
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Country | US
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Telephone | 619-461-1898
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Fax |
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Authorized Official
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Title or Position | PROVIDER/PRESIDENT
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Name | DR. DENNIS RICHMOND
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Credential | MD
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Telephone | 619-461-1898
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | A20244
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License Number State | CA
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