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General NPI Number Information
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NPI Number | 1790097145
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Entity Type | Organization
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Legal Business Name | LIFELINE WOUND CARE
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Dates
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Enumeration Date | 07/13/2010
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Last Update Date | 07/13/2010
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Provider Practice Location Address
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Address Line | 22361 PACIFIC COAST HWY STE 441
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City | MALIBU
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State | CA
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Zip | 90265
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Country | US
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Telephone | 818-992-1801
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Fax |
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Provider Business Mailing Address
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Address Line | 20301 VENTURA BLVD SUITE 115
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City | WOODLAND HILLS
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State | CA
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Zip | 91364-2447
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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 | PRESIDENT
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Name | DR. STEVEN KAYE
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Credential | M.D.
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Telephone | 310-871-3434
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | G29768
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License Number State | CA
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