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General NPI Number Information
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NPI Number | 1114721305
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Entity Type | Organization
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Legal Business Name | ARIZONA S ADVANCED WOUND CARE LLC
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Dates
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Enumeration Date | 04/04/2025
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Last Update Date | 04/04/2025
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Provider Practice Location Address
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Address Line | 2625 E CAMELBACK RD APT 288
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City | PHOENIX
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State | AZ
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Zip | 85016-4392
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Country | US
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Telephone | 725-251-3522
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Fax | 725-251-3488
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Provider Business Mailing Address
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Address Line | 3601 W SAHARA AVE STE 201
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City | LAS VEGAS
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State | NV
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Zip | 89102-5821
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Country | US
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Telephone | 725-251-3522
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Fax | 725-251-3488
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Authorized Official
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Title or Position | OWNER
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Name | MARIA JILL BUENA ALFONSO
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Credential |
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Telephone | 725-255-7865
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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