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General NPI Number Information
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NPI Number | 1932095809
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Entity Type | Organization
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Legal Business Name | ACTIVATE WOUND CARE LLC
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Dates
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Enumeration Date | 06/16/2025
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Last Update Date | 06/16/2025
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Provider Practice Location Address
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Address Line | 2626 S RAINBOW BLVD STE 102B
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City | LAS VEGAS
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State | NV
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Zip | 89146-4005
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Country | US
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Telephone | 702-845-7292
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Fax |
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Provider Business Mailing Address
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Address Line | 2626 S RAINBOW BLVD STE 102B
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City | LAS VEGAS
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State | NV
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Zip | 89146-4005
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Country | US
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Telephone | 702-845-7292
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MIGUEL ADRIAN AYUSTE YU
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Credential | MD
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Telephone | 702-845-7292
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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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