Provider Demographics
NPI:1982403424
Name:APOLLO MEDICAL WOUND CARE LLC
Entity type:Organization
Organization Name:APOLLO MEDICAL WOUND CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:HOMER
Authorized Official - Middle Name:
Authorized Official - Last Name:TUAZON
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:702-417-3865
Mailing Address - Street 1:4161 OCEANSIDE BLVD STE 5
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-6035
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4161 OCEANSIDE BLVD STE 5
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-6035
Practice Address - Country:US
Practice Address - Phone:858-648-7398
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-08
Last Update Date:2025-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty