MEDICARE: NOVA WOUND CARE MEDICAL CORP

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	208600000X	Surgery Physician

General Provider Information

NPI Number	:	1821968843
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOVA WOUND CARE MEDICAL CORP

Provider Business Mailing Address
First Line	:	8500 WILSHIRE BLVD STE 1020
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90211-3108
Country	:	US
Telephone Number	:	424-279-9610
Fax Number	:	310-360-6246

Provider Business Practice Location Address
First Line	:	8500 WILSHIRE BLVD STE 1020
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90211-3108
Country	:	US
Telephone Number	:	424-279-9610
Fax Number	:	310-360-6246

Authorized Official
Title or Position	:	PRACTICE OWNER
Name	:	FARDAD FOROUZANPOUR
Credential	:	DO
Telephone Number	:	424-279-9610

Provider Enumeration Date	:	11/05/2025
Last Update Date	:	12/12/2025

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