MEDICARE: SKINTEGRITY WOUND CARE

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	:	1427932938
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SKINTEGRITY WOUND CARE

Provider Business Mailing Address
First Line	:	17919 MACKESON CT
Second Line	:
City	:	CARSON
State	:	CA
Zip	:	90746-1629
Country	:	US
Telephone Number	:	310-644-8302
Fax Number	:

Provider Business Practice Location Address
First Line	:	17919 MACKESON CT
Second Line	:
City	:	CARSON
State	:	CA
Zip	:	90746-1629
Country	:	US
Telephone Number	:	310-644-8302
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	HENRY PEKUN
Credential	:
Telephone Number	:	310-877-5368

Provider Enumeration Date	:	08/05/2025
Last Update Date	:	08/05/2025

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Directions to “SKINTEGRITY WOUND CARE ” Practice Location

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