Provider Demographics
NPI:1295583250
Name:WOUND RESCUE SPECIALIST
Entity type:Organization
Organization Name:WOUND RESCUE SPECIALIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BEHROZ
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMKAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-763-3363
Mailing Address - Street 1:275 W HOSPITALITY LN STE 317
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-3265
Mailing Address - Country:US
Mailing Address - Phone:909-763-3363
Mailing Address - Fax:909-769-0109
Practice Address - Street 1:275 W HOSPITALITY LN STE 317
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3265
Practice Address - Country:US
Practice Address - Phone:909-763-3363
Practice Address - Fax:909-769-0109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-07
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty