Provider Demographics
NPI:1356966105
Name:WOUND PROS ARIZONA
Entity type:Organization
Organization Name:WOUND PROS ARIZONA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:AYODELE
Authorized Official - Last Name:OTIKO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-708-7668
Mailing Address - Street 1:5901 W CENTURY BLVD STE 750
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5443
Mailing Address - Country:US
Mailing Address - Phone:323-480-4075
Mailing Address - Fax:323-433-9177
Practice Address - Street 1:3651 E BASELINE RD STE E320
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2689
Practice Address - Country:US
Practice Address - Phone:480-590-1636
Practice Address - Fax:323-433-9177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-08
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty