| NPI | 1194694380 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY AVANESOV Owner 818-797-5030 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 163WW0000X Registered Nurse, Wound Care |
| Enumeration Date | 2025-11-04 |
| Last Update Date | 2025-11-04 |