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General NPI Number Information
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NPI Number | 1912143603
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Entity Type | Organization
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Legal Business Name | PREVENTATIVE WOUND CARE ASSOCIATES LLC
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Dates
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Enumeration Date | 12/30/2008
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Last Update Date | 12/30/2008
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Provider Practice Location Address
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Address Line | 9956 SAGO POINT DR
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City | LARGO
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State | FL
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Zip | 33777-4913
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Country | US
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Telephone | 727-239-3713
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Fax | 727-230-9046
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Provider Business Mailing Address
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Address Line | PO BOX 1457
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City | LARGO
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State | FL
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Zip | 33779-1457
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Country | US
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Telephone | 727-239-3713
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Fax | 727-230-9046
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. NAVIN REDDY
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Credential | MD
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Telephone | 727-230-6698
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | R300620764440
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | R300620764440
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License Number State | FL
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