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General NPI Number Information
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NPI Number | 1881417764
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Entity Type | Organization
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Legal Business Name | NEVADA MOBILE WOUND CARE PC
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Dates
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Enumeration Date | 11/07/2024
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Last Update Date | 11/07/2024
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Provider Practice Location Address
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Address Line | 675 FAIRVIEW DR STE 226-A
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City | CARSON CITY
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State | NV
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Zip | 89701-5629
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Country | US
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Telephone | 858-621-1514
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Fax | 858-585-4070
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Provider Business Mailing Address
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Address Line | 10089 WILLOW CREEK RD STE 200
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City | SAN DIEGO
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State | CA
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Zip | 92131-1699
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Country | US
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Telephone | 858-621-1514
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Fax | 858-585-4070
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Authorized Official
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Title or Position | CEO
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Name | BRADLEY B BAILEY
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Credential | MD
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Telephone | 858-621-1514
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207PE0005X
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Taxonomy Name | Undersea and Hyperbaric Medicine (Emergency Medicine) Physician
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License Number |
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License Number State |
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