Healthcare Provider Details

I. General information

NPI: 1780515270
Provider Name (Legal Business Name): NEXTGEN WOUND CARE SOLUTIONS PACIFIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10901 WOOLWICH WAY
MATHER CA
95655-3007
US

IV. Provider business mailing address

10901 WOOLWICH WAY
MATHER CA
95655-3007
US

V. Phone/Fax

Practice location:
  • Phone: 279-275-7050
  • Fax:
Mailing address:
  • Phone: 279-275-7050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: ALYSSA JOHNSTON
Title or Position: COO
Credential: FNP
Phone: 279-275-7050