| Regenerative Wound Solutions a Professional Corporation | |
|
2208 W Whittier Blvd Ste C La Habra CA 90631-3403 | |
| (562) 329-8647 | |
| Not Available |
| Full Name | Regenerative Wound Solutions a Professional Corporation |
|---|---|
| Speciality | Internal Medicine |
| Location | 2208 W Whittier Blvd Ste C, La Habra, California |
| Authorized Official Name and Position | Keith Carrillo (CEO) |
| Authorized Official Contact | 5626520923 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Regenerative Wound Solutions a Professional Corporation 2208 W Whittier Blvd Ste C La Habra CA 90631-3403 Ph: (562) 329-8647 | Regenerative Wound Solutions a Professional Corporation 2208 W Whittier Blvd Ste C La Habra CA 90631-3403 Ph: (562) 329-8647 |
| NPI Number | 1225902349 |
|---|---|
| Provider Enumeration Date | 10/01/2025 |
| Last Update Date | 10/01/2025 |
| Certification Date | 10/01/2025 |
| Medicare PECOS PAC ID | 9830681055 |
|---|---|
| Medicare Enrollment ID | O20251125002587 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225902349 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | () | Primary |
| Provider Name | Joshua P Peloquin |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1831636083 PECOS PAC ID: 0749536381 Enrollment ID: I20180711003334 |
| Provider Name | Keith Carrillo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265098784 PECOS PAC ID: 1355873340 Enrollment ID: I20241015003998 |
| Provider Name | Arjun Nyaupane |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063001444 PECOS PAC ID: 6305354291 Enrollment ID: I20250801003415 |
| Provider Name | Shin Il Kim |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578184966 PECOS PAC ID: 3072008044 Enrollment ID: I20251217004697 |
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