| Supportive Wound Care, Inc | |
|
1202 Monte Vista Ave Ste 6 Upland CA 91786-8209 | |
| (310) 435-7575 | |
| Not Available |
| Full Name | Supportive Wound Care, Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1202 Monte Vista Ave Ste 6, Upland, California |
| Authorized Official Name and Position | Lior Matian (CEO) |
| Authorized Official Contact | 3104357575 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Supportive Wound Care, Inc 1202 Monte Vista Ave Ste 6 Upland CA 91786-8209 Ph: () - | Supportive Wound Care, Inc 1202 Monte Vista Ave Ste 6 Upland CA 91786-8209 Ph: (310) 435-7575 |
| NPI Number | 1891545083 |
|---|---|
| Provider Enumeration Date | 03/22/2024 |
| Last Update Date | 03/22/2024 |
| Medicare PECOS PAC ID | 7315480001 |
|---|---|
| Medicare Enrollment ID | O20240622000370 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891545083 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Yousef W Ireifej |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1962693598 PECOS PAC ID: 2567556624 Enrollment ID: I20070919000997 |
| Provider Name | Maximo Diamond |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1063519932 PECOS PAC ID: 4082878699 Enrollment ID: I20120612000371 |
| Provider Name | Tamara Sue Pippin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508569567 PECOS PAC ID: 8628422532 Enrollment ID: I20231012000085 |
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