Provider Demographics
NPI:1083665319
Name:WEST COAST WOUND CARE INC
Entity type:Organization
Organization Name:WEST COAST WOUND CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:BUNKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-237-6797
Mailing Address - Street 1:941 MCLEAN AVE
Mailing Address - Street 2:SUITE 387
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10704-4107
Mailing Address - Country:US
Mailing Address - Phone:914-237-6797
Mailing Address - Fax:914-237-6790
Practice Address - Street 1:19700 HESPERIAN BLVD
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-4704
Practice Address - Country:US
Practice Address - Phone:914-237-6797
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100512081Medicaid
AZ337306Medicaid
CAZZZ02537ZMedicare PIN
AZZ118934Medicare PIN
NVV103246Medicare PIN
CADF9590Medicare PIN
CAW20128Medicare PIN
CAZZZ02536ZMedicare PIN
CAZZZ02535ZMedicare PIN
AZ337306Medicaid
CAZZZ02538ZMedicare PIN