Provider Demographics
NPI:1164256681
Name:MEDICUS VULNERUM INC
Entity type:Organization
Organization Name:MEDICUS VULNERUM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPER
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAMOY
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:954-609-2460
Mailing Address - Street 1:10280 GROVE LN
Mailing Address - Street 2:
Mailing Address - City:COOPER CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33328-4006
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10280 GROVE LN
Practice Address - Street 2:
Practice Address - City:COOPER CITY
Practice Address - State:FL
Practice Address - Zip Code:33328-4006
Practice Address - Country:US
Practice Address - Phone:954-609-2460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty