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General NPI Number Information
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NPI Number | 1821807264
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Entity Type | Organization
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Legal Business Name | HEALING WOUNDS MEDICAL GROUP
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Dates
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Enumeration Date | 12/31/2024
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Last Update Date | 12/31/2024
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Provider Practice Location Address
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Address Line | 50 W LEMON AVE STE 24
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City | MONROVIA
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State | CA
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Zip | 91016-6152
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Country | US
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Telephone | 626-290-6357
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Fax |
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Provider Business Mailing Address
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Address Line | 50 W LEMON AVE STE 24
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City | MONROVIA
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State | CA
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Zip | 91016-6152
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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 | CEO
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Name | ROBERT MATHIAS
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Credential |
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Telephone | 626-290-6357
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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