1376158725 NPI number — WOUND PROS WASHINGTON

Table of content: (NPI 1376158725)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376158725 NPI number — WOUND PROS WASHINGTON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WOUND PROS WASHINGTON
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376158725
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/02/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5901 W CENTURY BLVD STE 750
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90045-5443
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-480-4075
Provider Business Mailing Address Fax Number:
323-433-9177

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11335 NE 122ND
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
KIRKLAND
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98034-6933
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-496-5844
Provider Business Practice Location Address Fax Number:
323-433-9177
Provider Enumeration Date:
09/12/2020

Additional Information

Authorized Official

Authorized Official Last Name:
OTIKO
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
AYODELE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
818-836-2475

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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