NPIMap

Organization Active NPI

Infinity Wound Care Specialist

  • Wound Care Registered Nurse
  • Encino, CA
National Provider Identifier
1275361941
Registry record updated Sep 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Wound Care Registered NurseTaxonomy code 163WW0000X
Legal business name
INFINITY WOUND CARE SPECIALIST
Practice address
17337 Ventura Blvd Ste 220
Encino, CA 91316-4039
Phone
(818) 518-0146
NPI assigned
Jul 24, 2024
Last updated
Sep 25, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Concepcion Cabellon Samuels
Title
Ceo
Phone
(818) 418-4440

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Wound Care Registered Nurse 163WW0000X Primary
Surgery Physician 208600000X

Addresses

Primary practice location

17337 Ventura Blvd Ste 220
Encino, CA 91316-4039

Mailing address

17337 Ventura Blvd Ste 220
Encino, CA 91316-4039
Phone (818) 518-0146

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240925001872 CA Part B Supplier - Clinic/Group Practice 7810438264 Receives reassigned benefits from 12 practitioners
Practice locations: Encino, CA

National Provider Directory

National Provider Directory

Locations

17337 Ventura Blvd
Ste 220
Encino, CA 91316
Phone (818) 418-4440

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1721779200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727222400000",
    "number": "1275361941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17337 VENTURA BLVD STE 220",
            "city": "ENCINO",
            "state": "CA",
            "postal_code": "913164039",
            "telephone_number": "818-518-0146"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17337 VENTURA BLVD STE 220",
            "city": "ENCINO",
            "state": "CA",
            "postal_code": "913164039",
            "telephone_number": "818-518-0146"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INFINITY WOUND CARE SPECIALIST",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-24",
        "last_updated": "2024-09-25",
        "certification_date": "2024-09-25",
        "status": "A",
        "authorized_official_last_name": "SAMUELS",
        "authorized_official_first_name": "CONCEPCION",
        "authorized_official_middle_name": "CABELLON",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "818-418-4440",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "163WW0000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Wound Care",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Encino, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.