Provider Demographics
NPI:1235921032
Name:PERPETUAL WOUND RESCUE
Entity type:Organization
Organization Name:PERPETUAL WOUND RESCUE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MIKIO
Authorized Official - Middle Name:
Authorized Official - Last Name:TACHIBANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-808-0148
Mailing Address - Street 1:1100 E ORANGETHORPE AVE STE 200R
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-1144
Mailing Address - Country:US
Mailing Address - Phone:240-808-0148
Mailing Address - Fax:
Practice Address - Street 1:1100 E ORANGETHORPE AVE STE 200R
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-1144
Practice Address - Country:US
Practice Address - Phone:240-808-0148
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-19
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty