Healthcare Provider Details

I. General information

NPI: 1477427177
Provider Name (Legal Business Name): WOUNDXPERT AND PRIMARY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2025
Last Update Date: 10/03/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2131 HERNDON AVE STE 103
CLOVIS CA
93611-6304
US

IV. Provider business mailing address

5957 GORDON CREEK AVE
LAS VEGAS NV
89139-7113
US

V. Phone/Fax

Practice location:
  • Phone: 504-458-2467
  • Fax:
Mailing address:
  • Phone: 504-458-2467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LALAINE GARSULA
Title or Position: OWNER
Credential:
Phone: 504-458-2467