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General NPI Number Information
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NPI Number | 1760272124
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Entity Type | Organization
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Legal Business Name | PROVISION WOUND CARE INC
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Dates
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Enumeration Date | 05/08/2025
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Last Update Date | 05/08/2025
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Provider Practice Location Address
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Address Line | 15130 VENTURA BLVD STE 251
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City | SHERMAN OAKS
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State | CA
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Zip | 91403-3301
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Country | US
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Telephone | 310-269-6644
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Fax |
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Provider Business Mailing Address
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Address Line | 15130 VENTURA BLVD STE 251
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City | SHERMAN OAKS
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State | CA
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Zip | 91403-3301
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Country | US
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Telephone | 310-269-6644
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | SUSANNA BABAIAN
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Credential |
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Telephone | 310-269-6644
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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