Provider Demographics
NPI:1356067375
Name:WEST COAST WOUND CARE SPECIALISTS, LLC
Entity type:Organization
Organization Name:WEST COAST WOUND CARE SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:CAY
Authorized Official - Last Name:KITA
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:941-933-0223
Mailing Address - Street 1:4407 24TH AVE E
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:FL
Mailing Address - Zip Code:34221-6343
Mailing Address - Country:US
Mailing Address - Phone:941-933-0223
Mailing Address - Fax:833-464-5076
Practice Address - Street 1:4407 24TH AVE E
Practice Address - Street 2:
Practice Address - City:PALMETTO
Practice Address - State:FL
Practice Address - Zip Code:34221-6343
Practice Address - Country:US
Practice Address - Phone:810-599-1837
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-12
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center