Provider Demographics
NPI:1043977184
Name:THE WOUND CARE DOCTORS
Entity Type:Organization
Organization Name:THE WOUND CARE DOCTORS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT&CEO
Authorized Official - Prefix:
Authorized Official - First Name:BO
Authorized Official - Middle Name:
Authorized Official - Last Name:LIU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-569-0088
Mailing Address - Street 1:25044 PEACHLAND AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:NEWHALL
Mailing Address - State:CA
Mailing Address - Zip Code:91321-5730
Mailing Address - Country:US
Mailing Address - Phone:818-636-6749
Mailing Address - Fax:
Practice Address - Street 1:8608 UTICA AVE STE 218
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-4879
Practice Address - Country:US
Practice Address - Phone:626-569-0088
Practice Address - Fax:866-443-7567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-23
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty