NPIMap

Organization Active NPI

Wound Pros Nevada

  • General Practice Physician
  • Las Vegas, NV
National Provider Identifier
1053959791
Registry record updated May 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
WOUND PROS NEVADA
Practice address
1700 E Desert Inn Rd Ste 103
Las Vegas, NV 89169-3206
Phone
(888) 880-3451
NPI assigned
Dec 12, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 23, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Christopher Ayodele Otiko, DPMNPI 1346223997
Title
President
Phone
(818) 836-2475

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208D00000X Primary
Durable Medical Equipment & Medical Supplies 332B00000X

Addresses

Primary practice location

1700 E Desert Inn Rd Ste 103
Las Vegas, NV 89169-3206

Mailing address

4640 Admiralty Way Ste 500
Marina del Rey, CA 90292-6636
Phone (888) 880-3451

Other practice location 1

5940 S Rainbow Blvd Ste 2007
Las Vegas, NV 89118-2506
Phone (818) 836-2475

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1576108800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1653264000000",
    "number": "1053959791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4640 ADMIRALTY WAY STE 500",
            "city": "MARINA DEL REY",
            "state": "CA",
            "postal_code": "902926636",
            "telephone_number": "888-880-3451",
            "fax_number": "323-433-9177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 E DESERT INN RD STE 103",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891693206",
            "telephone_number": "888-880-3451"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5940 S Rainbow Blvd Ste 2007",
            "address_purpose": "LOCATION",
            "city": "Las Vegas",
            "state": "NV",
            "postal_code": "891182506",
            "country_code": "US",
            "telephone_number": "818-836-2475",
            "fax_number": "323-433-9177",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "WOUND PROS NEVADA",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-12-12",
        "last_updated": "2022-05-23",
        "certification_date": "2022-05-23",
        "status": "A",
        "authorized_official_last_name": "OTIKO",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "AYODELE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "818-836-2475",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.