Provider Demographics
NPI:1609762285
Name:WELLO WOUND CARE, LLC
Entity type:Organization
Organization Name:WELLO WOUND CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL PROVIDER AND LEADER
Authorized Official - Prefix:
Authorized Official - First Name:ROVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:224-425-1142
Mailing Address - Street 1:11413 ETIWANDA AVE
Mailing Address - Street 2:
Mailing Address - City:PORTER RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91326-2013
Mailing Address - Country:US
Mailing Address - Phone:224-425-1142
Mailing Address - Fax:
Practice Address - Street 1:11239 VENTURA BLVD
Practice Address - Street 2:STE 212, UNIT 2
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604
Practice Address - Country:US
Practice Address - Phone:224-425-1142
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-17
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty