Provider Demographics
NPI:1578217451
Name:OPTIMUM WOUND CARE INC
Entity Type:Organization
Organization Name:OPTIMUM WOUND CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:SOHEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:DELRAHIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:877-343-6885
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:661-383-7136
Mailing Address - Fax:818-356-4380
Practice Address - Street 1:22151 VENTURA BLVD STE 101
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-1666
Practice Address - Country:US
Practice Address - Phone:877-343-6885
Practice Address - Fax:844-343-9337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty