MEDICARE: ELITE WOUND CARE & MEDICAL SERVICES, INC

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	261QM2500X	Medical Specialty Clinic/Center

General Provider Information

NPI Number	:	1275211138
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELITE WOUND CARE & MEDICAL SERVICES, INC

Provider Business Mailing Address
First Line	:	4312 WOODMAN AVE STE 300
Second Line	:
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91423-5514
Country	:	US
Telephone Number	:	747-877-2788
Fax Number	:	747-877-2886

Provider Business Practice Location Address
First Line	:	4312 WOODMAN AVE STE 300
Second Line	:
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91423-5514
Country	:	US
Telephone Number	:	747-877-2788
Fax Number	:	747-877-2886

Authorized Official
Title or Position	:	CEO
Name	:	JULIE S GRAND
Credential	:
Telephone Number	:	818-305-6998

Provider Enumeration Date	:	07/10/2023
Last Update Date	:	02/11/2026

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