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 |
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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 |
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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 |
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Provider Enumeration Date | 03/22/2024 |
Last Update Date | 03/22/2024 |
Medicare PECOS PAC ID | 7315480001 |
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Medicare Enrollment ID | O20240622000370 |
Identifier | Type | State | Issuer |
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1891545083 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261Q00000X | Clinic/center | (* (Not Available)) | Primary |
Provider Name | Yousef W Ireifej |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1962693598 PECOS PAC ID: 2567556624 Enrollment ID: I20070919000997 |
Provider Name | Tamara Sue Pippin |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1508569567 PECOS PAC ID: 8628422532 Enrollment ID: I20231012000085 |
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Inland Empire Medical Network,inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 585 N Mountain Ave, Suite C, Upland, CA 91786 Phone: 909-981-8599 Fax: 909-981-5441 | |
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