Healthcare Provider Details

I. General information

NPI: 1003706524
Provider Name (Legal Business Name): REGEN WOUND SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2025
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6272 SPRING MOUNTAIN RD STE 110
LAS VEGAS NV
89146-8876
US

IV. Provider business mailing address

6272 SPRING MOUNTAIN RD STE 110
LAS VEGAS NV
89146-8876
US

V. Phone/Fax

Practice location:
  • Phone: 702-861-0254
  • Fax: 702-425-5540
Mailing address:
  • Phone: 702-861-0254
  • Fax: 702-425-5540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: REX CHRISTOPHER ROBLEDO
Title or Position: PRESIDENT
Credential:
Phone: 702-883-0850