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NPI Code Detail

MEDICARE: CRESCENT WOUND CARE INC

MEDICARE: CRESCENT WOUND CARE 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
1208600000XSurgery Physician

General Provider Information

NPI Number : 1902749641
Entity Type Code : Organization
Provider Name (Legal Business Name) : CRESCENT WOUND CARE INC
Provider Business Mailing Address
First Line : 5580 LA JOLLA BLVD STE 622
Second Line :
City : LA JOLLA
State : CA
Zip : 92037-7651
Country : US
Telephone Number : 858-221-7726
Fax Number : 858-431-4736
Provider Business Practice Location Address
First Line : 765 W NASA BLVD
Second Line :
City : MELBOURNE
State : FL
Zip : 32901-1815
Country : US
Telephone Number : 321-733-5725
Fax Number : 321-733-5799
Authorized Official
Title or Position : OWNER
Name : MOHAMED KADRY-HASSANEIN
Credential : MD
Telephone Number : 858-967-3070
Provider Enumeration Date : 04/09/2026
Last Update Date : 04/17/2026

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Directions to “CRESCENT WOUND CARE INC ” Practice Location

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