Organization Active NPI

Advanced Practice Wound Care and Psyche Specialist

  • Wound Care Registered Nurse
  • Rancho Cucamonga, CA
National Provider Identifier
1063260073
Registry record updated May 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Wound Care Registered NurseTaxonomy code 163WW0000X
Legal business name
ADVANCED PRACTICE WOUND CARE AND PSYCHE SPECIALIST
Practice address
10970 Arrow Route
#214
Rancho Cucamonga, CA 91730
Phone
(626) 347-8548
NPI assigned
May 7, 2024
Last updated
May 7, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 7, 2024

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

Authorized official

Name
Jazmeen Inguito
Title
Owner/Authorized Official
Phone
(626) 347-8548

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Wound Care Registered Nurse 163WW0000X Primary
Family Nurse Practitioner 363LF0000X
Psychiatric/Mental Health Nurse Practitioner 363LP0808X

Addresses

Primary practice location

10970 Arrow Route
#214
Rancho Cucamonga, CA 91730

Mailing address

10970 Arrow Route
#214
Rancho Cucamonga, CA 91730

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241011002972 CA Part B Supplier - Clinic/Group Practice 1456883719 Receives reassigned benefits from 6 practitioners
Practice locations: Rancho Cucamonga, CA

National Provider Directory

National Provider Directory

Locations

10970 Arrow Rte
Ste 214
Rancho Cucamonga, CA 91730
Phone (626) 347-8548

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1715040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715040000000",
    "number": "1063260073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10970 ARROW ROUTE",
            "address_2": "#214",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "91730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10970 ARROW ROUTE",
            "address_2": "#214",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "91730",
            "telephone_number": "626-347-8548"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED PRACTICE WOUND CARE AND PSYCHE SPECIALIST",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-07",
        "last_updated": "2024-05-07",
        "certification_date": "2024-04-30",
        "status": "A",
        "authorized_official_last_name": "INGUITO",
        "authorized_official_first_name": "JAZMEEN",
        "authorized_official_title_or_position": "OWNER/AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "626-347-8548"
    },
    "taxonomies": [
        {
            "code": "163WW0000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Wound Care",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rancho Cucamonga, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.