Provider Demographics
NPI:1063260073
Name:ADVANCED PRACTICE WOUND CARE AND PSYCHE SPECIALIST
Entity type:Organization
Organization Name:ADVANCED PRACTICE WOUND CARE AND PSYCHE SPECIALIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JAZMEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:INGUITO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-347-8548
Mailing Address - Street 1:10970 ARROW ROUTE
Mailing Address - Street 2:#214
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10970 ARROW ROUTE
Practice Address - Street 2:#214
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730
Practice Address - Country:US
Practice Address - Phone:626-347-8548
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-07
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty