Provider Demographics
NPI:1821969452
Name:A WOUND PLACE INNOVATIONS GROUP LLC
Entity type:Organization
Organization Name:A WOUND PLACE INNOVATIONS GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBT NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-413-6310
Mailing Address - Street 1:5050 PALO VERDE ST STE 109
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-2333
Mailing Address - Country:US
Mailing Address - Phone:909-413-6310
Mailing Address - Fax:909-975-2507
Practice Address - Street 1:5050 PALO VERDE ST STE 109
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-2333
Practice Address - Country:US
Practice Address - Phone:714-883-6651
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-16
Last Update Date:2025-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty