| Elite Wound Care Pro | |
|
11428 Artesia Blvd Ste 26 Artesia CA 90701-3883 | |
| (714) 600-5396 | |
| Not Available |
| Full Name | Elite Wound Care Pro |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 11428 Artesia Blvd Ste 26, Artesia, California |
| Authorized Official Name and Position | Rosemarie Soriano (PROVIDER) |
| Authorized Official Contact | 7146005396 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Elite Wound Care Pro 11428 Artesia Blvd Ste 26 Artesia CA 90701-3883 Ph: () - | Elite Wound Care Pro 11428 Artesia Blvd Ste 26 Artesia CA 90701-3883 Ph: (714) 600-5396 |
| NPI Number | 1548024920 |
|---|---|
| Provider Enumeration Date | 02/07/2024 |
| Last Update Date | 02/07/2024 |
| Medicare PECOS PAC ID | 0042656399 |
|---|---|
| Medicare Enrollment ID | O20240309000387 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548024920 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| 363LF0000X | Nurse Practitioner - Family | (* (Not Available)) | Primary |
| Provider Name | Phillip Tafoya |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1073509469 PECOS PAC ID: 4183657455 Enrollment ID: I20050916000257 |
| Provider Name | Rosemarie Soriano |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477327724 PECOS PAC ID: 7315104155 Enrollment ID: I20240309000412 |
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