Provider Demographics
NPI:1275361941
Name:INFINITY WOUND CARE SPECIALIST
Entity type:Organization
Organization Name:INFINITY WOUND CARE SPECIALIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:CONCEPCION
Authorized Official - Middle Name:CABELLON
Authorized Official - Last Name:SAMUELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-418-4440
Mailing Address - Street 1:17337 VENTURA BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-4039
Mailing Address - Country:US
Mailing Address - Phone:818-518-0146
Mailing Address - Fax:
Practice Address - Street 1:17337 VENTURA BLVD STE 220
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-4039
Practice Address - Country:US
Practice Address - Phone:818-518-0146
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-24
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Single Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty