Healthcare Provider Details

I. General information

NPI: 1306603329
Provider Name (Legal Business Name): THRIVE SKIN WOUND CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2024
Last Update Date: 03/05/2024
Certification Date: 03/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 RYLAND ST # 200-1
RENO NV
89502-1659
US

IV. Provider business mailing address

PO BOX 61657
IRVINE CA
92602-6055
US

V. Phone/Fax

Practice location:
  • Phone: 702-518-1428
  • Fax:
Mailing address:
  • Phone: 916-317-8796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. TYNA NGUYEN
Title or Position: OFFICE MANAGER
Credential:
Phone: 916-317-8796