Provider Demographics
NPI:1811726862
Name:STAT MEDICAL AND WOUND CARE SPECIALISTS INC
Entity type:Organization
Organization Name:STAT MEDICAL AND WOUND CARE SPECIALISTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALDWIN
Authorized Official - Middle Name:E
Authorized Official - Last Name:JOSE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:626-756-6017
Mailing Address - Street 1:1619 W GARVEY AVE N STE 106
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-2146
Mailing Address - Country:US
Mailing Address - Phone:626-756-6017
Mailing Address - Fax:747-206-5034
Practice Address - Street 1:1619 W GARVEY AVE N STE 106
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-2146
Practice Address - Country:US
Practice Address - Phone:626-756-6017
Practice Address - Fax:747-206-5034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty