Provider Demographics
NPI:1174497283
Name:INNOVATIVE WOUND SOLUTIONS
Entity type:Organization
Organization Name:INNOVATIVE WOUND SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HUSAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ELIAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-407-4416
Mailing Address - Street 1:301 S FAIR OAKS AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-2536
Mailing Address - Country:US
Mailing Address - Phone:213-407-4416
Mailing Address - Fax:
Practice Address - Street 1:301 S FAIR OAKS AVE STE 106
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-2536
Practice Address - Country:US
Practice Address - Phone:213-407-4416
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-01
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty