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General NPI Number Information
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NPI Number | 1396629176
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Entity Type | Organization
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Legal Business Name | SYNERGY WOUND 360 PLLC
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Dates
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Enumeration Date | 08/04/2025
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Last Update Date | 09/30/2025
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Provider Practice Location Address
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Address Line | 9070 E DESERT COVE AVE # A103
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City | SCOTTSDALE
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State | AZ
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Zip | 85260-6227
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Country | US
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Telephone | 480-553-6168
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Fax | 480-779-8905
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Provider Business Mailing Address
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Address Line | 9070 E DESERT COVE AVE # A103
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City | SCOTTSDALE
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State | AZ
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Zip | 85260-6227
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Country | US
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Telephone | 480-553-6168
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Fax | 480-779-8905
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | VINAMRA JAIN
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Credential | MD
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Telephone | 480-553-6168
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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