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General NPI Number Information
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NPI Number | 1306603329
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Entity Type | Organization
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Legal Business Name | THRIVE SKIN WOUND CARE PLLC
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Dates
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Enumeration Date | 03/05/2024
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Last Update Date | 03/05/2024
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Provider Practice Location Address
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Address Line | 401 RYLAND ST # 200-1
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City | RENO
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State | NV
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Zip | 89502-1659
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Country | US
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Telephone | 702-518-1428
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 61657
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City | IRVINE
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State | CA
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Zip | 92602-6055
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Country | US
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Telephone | 916-317-8796
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. TYNA NGUYEN
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Credential |
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Telephone | 916-317-8796
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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