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General NPI Number Information
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NPI Number | 1174208763
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Entity Type | Organization
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Legal Business Name | PLATINUM WOUND CARE SPECIALIST
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Dates
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Enumeration Date | 06/20/2023
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Last Update Date | 08/06/2025
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Provider Practice Location Address
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Address Line | 3830 E FLAMINGO RD STE 201
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City | LAS VEGAS
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State | NV
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Zip | 89121-6234
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Country | US
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Telephone | 702-659-5604
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Fax | 702-660-6186
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Provider Business Mailing Address
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Address Line | 1000 N GREEN VALLEY PKWY STE 440-127
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City | HENDERSON
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State | NV
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Zip | 89074-6170
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Country | US
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Telephone | 702-659-5604
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Fax | 702-660-6186
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Authorized Official
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Title or Position | OWNER
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Name | CRAIG JORGENSON
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Credential |
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Telephone | 702-659-5604
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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