MEDICARE: MDWOUND 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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1558173302
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MDWOUND LLC

Provider Business Mailing Address
First Line	:	12828 10TH ST
Second Line	:
City	:	CHINO
State	:	CA
Zip	:	91710-4255
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12828 10TH ST
Second Line	:
City	:	CHINO
State	:	CA
Zip	:	91710-4255
Country	:	US
Telephone Number	:	702-540-8097
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JHOETTE DUMLAO
Credential	:	MD
Telephone Number	:	702-540-8097

Provider Enumeration Date	:	01/20/2025
Last Update Date	:	01/20/2025

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Directions to “MDWOUND LLC ” Practice Location

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