Provider Demographics
NPI:1275787145
Name:TOWER WOUND CARE CENTER MEDICAL GROUP OF SANTA MONICA, INC.
Entity Type:Organization
Organization Name:TOWER WOUND CARE CENTER MEDICAL GROUP OF SANTA MONICA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:ARONOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-659-0705
Mailing Address - Street 1:8635 W 3RD ST
Mailing Address - Street 2:STE 1090W
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-6101
Mailing Address - Country:US
Mailing Address - Phone:310-659-0705
Mailing Address - Fax:310-659-0952
Practice Address - Street 1:1301 20TH ST
Practice Address - Street 2:STE 470
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404
Practice Address - Country:US
Practice Address - Phone:310-453-2702
Practice Address - Fax:310-453-2916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-05
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB50507208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty