MEDICARE: MILLENIUM WOUND CARE THERAPY

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1326868712
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILLENIUM WOUND CARE THERAPY

Provider Business Mailing Address
First Line	:	4914 LANKERSHIM BLVD STE 15
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91601-5376
Country	:	US
Telephone Number	:	209-508-2926
Fax Number	:	209-508-2929

Provider Business Practice Location Address
First Line	:	4914 LANKERSHIM BLVD STE 15
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91601-5376
Country	:	US
Telephone Number	:	209-508-2926
Fax Number	:	209-508-2929

Authorized Official
Title or Position	:	OWNER
Name	:	KAREN ASLANYAN
Credential	:
Telephone Number	:	209-508-2926

Provider Enumeration Date	:	10/11/2024
Last Update Date	:	10/11/2024

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