Healthcare Provider Details

I. General information

NPI: 1336853019
Provider Name (Legal Business Name): SAGUARO WOUND CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2023
Last Update Date: 10/03/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7140 E ROSEWOOD ST STE 110
TUCSON AZ
85710-1346
US

IV. Provider business mailing address

3650 N CAMINO OJO DE AGUA
TUCSON AZ
85749-7811
US

V. Phone/Fax

Practice location:
  • Phone: 520-440-3004
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL LAVOR
Title or Position: OWNER
Credential: MD
Phone: 520-440-3004