MEDICARE: GOOD SAMARITAN TRANSITIONAL CARE & WOUND SPECIALIST

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1437723632
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOOD SAMARITAN TRANSITIONAL CARE & WOUND SPECIALIST

Provider Business Mailing Address
First Line	:	9280 W SUNSET RD STE 410
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-4862
Country	:	US
Telephone Number	:	702-476-5114
Fax Number	:	888-593-0305

Provider Business Practice Location Address
First Line	:	9280 W SUNSET RD STE 410
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-4862
Country	:	US
Telephone Number	:	702-476-5114
Fax Number	:	888-593-0305

Authorized Official
Title or Position	:	MANAGER
Name	:	RON ELY VILLACRUCIS
Credential	:
Telephone Number	:	702-332-3967

Provider Enumeration Date	:	05/13/2021
Last Update Date	:	05/26/2026

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Directions to “GOOD SAMARITAN TRANSITIONAL CARE & WOUND SPECIALIST ” Practice Location

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