Provider Demographics
NPI:1346040151
Name:WELLNESS WOUND CARE INC
Entity type:Organization
Organization Name:WELLNESS WOUND CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ABRAHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:TAGVORYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:747-264-0266
Mailing Address - Street 1:19633 VENTURA BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-7110
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19633 VENTURA BLVD STE A
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-7110
Practice Address - Country:US
Practice Address - Phone:747-264-0266
Practice Address - Fax:747-264-0233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-19
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty