=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992513899
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOLLISTIC WOUND CARE OF LAS VEGAS PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/23/2024
-----------------------------------------------------
Last Update Date | 10/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8879 W FLAMINGO RD STE 101
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89147-8732
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-526-0919
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8879 W FLAMINGO RD STE 101
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89147-8732
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-526-0919
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING MEMBER
-----------------------------------------------------
Name | MR. JOEL SILVA
-----------------------------------------------------
Credential | APRN
-----------------------------------------------------
Telephone | 480-526-0919
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------