Moderm Wound Care Specialist LLC

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

MODERM WOUND CARE SPECIALIST LLC

Practice address

2263 Finch Cir
San Jacinto, CA 92582-6964

Phone

(888) 211-1498

NPI assigned

Aug 4, 2025

Organization subpart

No

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

Authorized official

Name

Tamara PippinNPI 1508569567

Title

Owner

Phone

(888) 211-1498

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Tamara Sue Pippin, FNP

  • Family Nurse Practitioner
  • San Jacinto, CA
  • NPI 1508569567

  CA

  Medicare reassignment NPD Authorized official
• Philip Zhou, D.O.

  • General Practice Physician
  • Westminster, CA
  • NPI 1770967622

  General Practice

  NPD

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

{
    "created_epoch": "1754265600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1754265600000",
    "number": "1538043211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2263 FINCH CIR",
            "city": "SAN JACINTO",
            "state": "CA",
            "postal_code": "925826964"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2263 FINCH CIR",
            "city": "SAN JACINTO",
            "state": "CA",
            "postal_code": "925826964",
            "telephone_number": "888-211-1498"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERM WOUND CARE SPECIALIST LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-08-04",
        "last_updated": "2025-08-04",
        "certification_date": "2025-08-04",
        "status": "A",
        "authorized_official_last_name": "PIPPIN",
        "authorized_official_first_name": "TAMARA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "888-211-1498"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Miriam Elizabeth Mirmotahari, NP
• Noel Emmanuel Wagayen Mislang, NP
• Paul Martin Mitchell, PHYSICIAN ASSISTANT
• Mobile Phlebotomist Services
• Moderm Medical Solutions Ca Inc.
• Kenneth Alan Monte, D.O.
• Tanna Victoria Montecino, LMFT
• Melinda Montes
• Sylvia Montes
• Brandi Lynn Moore

• All providers in San Jacinto, CA
• General Practice Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2025; 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.