Provider Demographics
NPI:1114721305
Name:ARIZONA S ADVANCED WOUND CARE LLC
Entity type:Organization
Organization Name:ARIZONA S ADVANCED WOUND CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA JILL
Authorized Official - Middle Name:BUENA
Authorized Official - Last Name:ALFONSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:725-255-7865
Mailing Address - Street 1:3601 W SAHARA AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-5821
Mailing Address - Country:US
Mailing Address - Phone:725-251-3522
Mailing Address - Fax:725-251-3488
Practice Address - Street 1:2625 E CAMELBACK RD APT 288
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4392
Practice Address - Country:US
Practice Address - Phone:725-251-3522
Practice Address - Fax:725-251-3488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-04
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty