MEDICARE: NEVADA WOUND CARE CLINIC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WW0000X	Wound Care Registered Nurse
2	363L00000X	Nurse Practitioner

General Provider Information

NPI Number	:	1225966195
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEVADA WOUND CARE CLINIC LLC

Provider Business Mailing Address
First Line	:	2350 S JONES BLVD STE E5
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-3103
Country	:	US
Telephone Number	:	702-906-7737
Fax Number	:

Provider Business Practice Location Address
First Line	:	2350 S JONES BLVD STE E5
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-3103
Country	:	US
Telephone Number	:	702-906-7737
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	KENNY ALEJANDRA AVILES LEON
Credential	:
Telephone Number	:	702-906-7737

Provider Enumeration Date	:	05/11/2026
Last Update Date	:	05/11/2026

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