Provider Demographics
NPI:1942090097
Name:ADVANCED WOUND CARE SPECIALISTS
Entity type:Organization
Organization Name:ADVANCED WOUND CARE SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:E
Authorized Official - Last Name:AIYETIWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-989-7700
Mailing Address - Street 1:10970 ARROW ROUTE
Mailing Address - Street 2:206
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-4839
Mailing Address - Country:US
Mailing Address - Phone:909-989-7700
Mailing Address - Fax:909-657-1050
Practice Address - Street 1:10970 ARROW ROUTE
Practice Address - Street 2:206
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-4839
Practice Address - Country:US
Practice Address - Phone:909-989-7700
Practice Address - Fax:909-657-1050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-12
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No251J00000XAgenciesNursing CareGroup - Single Specialty