Provider Demographics
NPI:1841920501
Name:CRESCENT WOUND CARE INC
Entity type:Organization
Organization Name:CRESCENT WOUND CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:
Authorized Official - Last Name:KADRY-HASSANEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-967-3070
Mailing Address - Street 1:5580 LA JOLLA BLVD # 622
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-7651
Mailing Address - Country:US
Mailing Address - Phone:858-936-7307
Mailing Address - Fax:
Practice Address - Street 1:1310 W GRANGER AVE
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-3911
Practice Address - Country:US
Practice Address - Phone:858-936-7307
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-15
Last Update Date:2024-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty