Healthcare Provider Details

I. General information

NPI: 1922806017
Provider Name (Legal Business Name): SUN VALLEY WOUND CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2025
Last Update Date: 07/14/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 W BROWN ROAD SUITE 3001, 3RD FLOOR
MESA AZ
85201-3221
US

IV. Provider business mailing address

560 W BROWN ROAD SUITE 3001, 3RD FLOOR
MESA AZ
85201-3221
US

V. Phone/Fax

Practice location:
  • Phone: 602-686-0059
  • Fax: 480-686-8263
Mailing address:
  • Phone: 602-686-0059
  • Fax: 480-686-8263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: BERTHA LUISA PINTO MORANTE
Title or Position: MANAGER
Credential:
Phone: 602-686-0059