MEDICARE: PHX MOBILE WOUND CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner
2	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1184590598
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHX MOBILE WOUND CARE LLC

Provider Business Mailing Address
First Line	:	121 S HOPE ST APT 416
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90012-5018
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	121 S HOPE ST APT 416
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90012-5018
Country	:	US
Telephone Number	:	602-851-1266
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ANDREW EPSTEIN
Credential	:
Telephone Number	:	602-851-1266

Provider Enumeration Date	:	10/13/2025
Last Update Date	:	10/13/2025

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