Organization Active NPI

Stellar Wound Solutions

  • Family Medicine Physician
  • Encino, CA
National Provider Identifier
1720969033
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
STELLAR WOUND SOLUTIONS
Practice address
5535 Balboa Blvd Ste 201
Encino, CA 91316-1525
Phone
(818) 804-8013
NPI assigned
Sep 11, 2025
Organization subpart
Yes
Parent organization
STERLING PEAK CAPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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

Authorized official

Name
Charlie Canonigo
Title
Ceo / Administrator
Phone
(818) 804-8013

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

5535 Balboa Blvd Ste 201
Encino, CA 91316-1525

Mailing address

5535 Balboa Blvd Ste 201
Encino, CA 91316-1525
Phone (818) 804-8013

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20251126002167 CA Part B Supplier - Clinic/Group Practice 8022500933 Receives reassigned benefits from 1 practitioner
Practice locations: Encino, CA

National Provider Directory

National Provider Directory

Locations

5535 Balboa Blvd
Ste 201
Encino, CA 91316
Phone (818) 804-8013

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1757548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1720969033",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5535 BALBOA BLVD STE 201",
            "city": "ENCINO",
            "state": "CA",
            "postal_code": "913161525",
            "telephone_number": "818-804-8013"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5535 BALBOA BLVD STE 201",
            "city": "ENCINO",
            "state": "CA",
            "postal_code": "913161525",
            "telephone_number": "818-804-8013"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STELLAR WOUND SOLUTIONS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "STERLING PEAK CAPITAL",
        "enumeration_date": "2025-09-11",
        "last_updated": "2025-09-11",
        "certification_date": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "CANONIGO",
        "authorized_official_first_name": "CHARLIE",
        "authorized_official_title_or_position": "CEO / ADMINISTRATOR",
        "authorized_official_telephone_number": "818-804-8013"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "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 11, 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.