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General NPI Number Information
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NPI Number | 1003617242
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Entity Type | Organization
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Legal Business Name | SKIN AID LLC
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Dates
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Enumeration Date | 03/24/2025
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Last Update Date | 04/02/2025
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Provider Practice Location Address
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Address Line | 7784 CAPE COD BAY CT
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City | LAS VEGAS
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State | NV
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Zip | 89179-1425
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Country | US
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Telephone | 702-741-8825
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Fax |
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Provider Business Mailing Address
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Address Line | 7784 CAPE COD BAY CT
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City | LAS VEGAS
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State | NV
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Zip | 89179-1425
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Country | US
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Telephone | 702-826-0956
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | THERESA MONTECILLO
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Credential | NP
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Telephone | 702-826-0956
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 163WW0000X
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Taxonomy Name | Wound Care Registered Nurse
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License Number |
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License Number State |
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