Active NPI 1275947764 Individual Practitioner Male Practitioner

Dr. Michael Zumwalt , MD

Dermatology • Reno, NV

✓ Accepts Medicare Assignment

Professional Overview & Biography Verified Profile Summary

Dr. Michael Zumwalt, MD is a certified Dermatology practicing in Reno, NV. With approximately 12 years of clinical experience since graduating from Loma Linda University School Of Medicine in 2014, Dr. Zumwalt delivers high-quality medical care to the local community at 640 W MOANA LN.

Dr. Zumwalt is affiliated with Mountain West Derm - Blackhart Pllc and accepts Medicare assignment.

Frequently performed procedures and clinical services include removal and microscopic exam of growth of head, neck, hands, feet, or genitals, removal and microscopic exam of growth of head, neck, hands, feet, or genitals, 1-5 tissue blocks, repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs. Full Medicare procedure pricing transparency rates and service volume details are listed on this profile.

Practice Location & Contact Primary Location

Practice Address

640 W Moana Ln

Reno, NV 895094903

Telephone 7753240699

Associated Practice Facility / Clinic

🏢 Mountain West Derm - Blackhart Pllc Facility NPI 1740633015

Medicare Profile & Education

Medical School

Loma Linda University School Of Medicine

Graduation Year

2014

Medicare Assignment

✓ Accepts Assignment

Telehealth Flag

In-Person Only

Specialty Benchmarks & Practice Insights

Comparative analytics for Dermatology in Reno, NV

Established Specialist (10-20 Yrs)

Practitioner Clinical Experience

12 Yrs -9.9 yrs vs City Avg

City Avg: 21.9 Yrs

State Avg: 19.7 Yrs

Regional Practice Density

27 Specialists

Practicing in Reno, NV (93 Statewide)

Telehealth Adoption Rate

0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount

59.6% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Clinical Seniority & Experience Comparison

Dr. Zumwalt (12 Years) 12 Yrs

Reno Specialty Average (21.9 Years) 21.9 Yrs

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2024)

Reporting Year:

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17312 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, each additional stage, 1-5 tissue blocks	721	345	$847.58	$403.53
17311 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, 1-5 tissue blocks	697	505	$1402.83	$511.99
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	326	250	$905.62	$293.99
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	290	256	$1167.22	$244.62
99213 Established patient office or other outpatient visit, typically 15 minutes	253	208	$187.84	$88.89
17313 Removal and microscopic exam of growth of trunk, arms, or legs, 1-5 tissue blocks	175	138	$1311.78	$592.13
17003 Destruction of precancer skin growth, 2-14 growths	159	20	$14.82	$6.56
11102 Tangential biopsy of single skin lesion	120	92	$214.30	$78.28
11103 Biopsy of related skin growth, each additional growth	113	37	$112.09	$49.24
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	95	83	$601.13	$140.50
13101 Complicated repair of wound of trunk, 2.6-7.5 cm	93	88	$844.02	$341.99
17314 Removal and microscopic exam of growth of trunk, arms, or legs, each additional stage, 1-5 tissue blocks	86	61	$810.46	$387.08
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	82	39	$3.58	$0.95
11900 Injection into skin growth, 1-7 growths	75	39	$118.01	$53.01
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	74	69	$526.52	$121.45
15240 Relocation of patient skin to forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet (20 sq centimeters or less)	57	55	$1980.19	$822.20
14041 Repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet by transferring skin, 10.1-30.0 sq cm	56	55	$2001.28	$861.73
14301 Repair of wound by transferring skin, 30.1-60.0 sq cm	50	46	$2283.70	$1035.47
14060 Repair of wound of eyelids, nose, ears, or lips by transferring skin, 10.0 sq cm or less	40	40	$1646.20	$732.92
88331 Pathology examination of specimen during surgery, first tissue block	37	27	$210.50	$98.59
17000 Destruction of skin growth	36	30	$159.14	$41.60
17004 Destruction of precancer skin growth, 15 or more growths	31	20	$350.57	$164.52
13152 Complicated repair of wound of eyelids, nose, ears, or lip, 2.6-7.5 cm	28	28	$1129.85	$242.28
13122 Complicated repair of wound of scalp, arms, or legs, each additional 5.0 cm or less	27	27	$282.19	$123.16
15220 Relocation of patient skin (20 sq centimeters or less) to scalp, arms, and/or legs	26	25	$1607.64	$710.29
11604 Removal of cancer skin growth of body, arms, or legs, 3.1-4.0 cm	24	24	$667.98	$177.15
15120 Skin graft of face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 100 sq cm or less, or 1% body area of infants and children)	24	24	$1800.95	$822.54
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	23	22	$115.22	$55.30
15260 Relocation of patient skin to nose, ears, eyelids, and/or lips (20 sq centimeters or less)	23	23	$2149.00	$978.12
14061 Repair of wound of eyelids, nose, ears, or lips by transferring skin, 10.1-30.0 sq cm	22	22	$2153.65	$930.31
14302 Repair of wound by transferring skin, each additional 30.0 sq cm	22	13	$487.92	$204.78
14040 Repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet by transferring skin, 10.0 sq cm or less	21	21	$1614.78	$742.03
15630 Transfer of skin flap to eyelids, nose, ears, or lips	20	20	$960.70	$437.88
13131 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 1.1-2.5 cm	20	20	$822.74	$237.08
15576 Creation of flap graft to eyelids, nose, ears, lips, or mouth	19	19	$1709.54	$763.56
11402 Removal of noncancer skin growth of body, arms, or legs, 1.1-2.0 cm	16	15	$360.38	$84.47
13133 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, each additional 5.0 cm or less	13	13	$378.32	$163.23
13102 Complicated repair of wound of trunk, each additional 5.0 cm or less	13	13	$257.10	$113.31
14021 Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of the scalp, arms, and/or legs	13	13	$1846.98	$848.74
13151 Complicated repair of wound of eyelids, nose, ears, or lip, 1.1-2.5 cm	12	12	$896.10	$206.21
11643 Removal of malignant growth (2.1 to 3.0 centimeters) of the face, ears, eyelids, nose, or lips	12	11	$677.89	$279.10

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17311 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, 1-5 tissue blocks	696	519	$1402.83	$475.64
17312 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, each additional stage, 1-5 tissue blocks	667	352	$847.58	$412.58
17003 Destruction of precancer skin growth, 2-14 growths	298	48	$14.82	$6.67
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	298	249	$905.62	$322.44
99213 Established patient office or other outpatient visit, typically 15 minutes	271	229	$187.84	$90.42
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	211	192	$1167.22	$260.30
11102 Tangential biopsy of single skin lesion	175	133	$214.30	$83.37
17313 Removal and microscopic exam of growth of trunk, arms, or legs, 1-5 tissue blocks	134	110	$1311.78	$597.43
11103 Biopsy of related skin growth, each additional growth	134	48	$112.09	$50.60
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	89	83	$601.13	$144.35
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	84	80	$526.52	$123.71
14041 Repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet by transferring skin, 10.1-30.0 sq cm	83	78	$2001.28	$911.63
17000 Destruction of skin growth	78	66	$159.14	$43.88
14301 Repair of wound by transferring skin, 30.1-60.0 sq cm	74	69	$2283.70	$1097.16
14060 Repair of wound of eyelids, nose, ears, or lips by transferring skin, 10.0 sq cm or less	73	71	$1646.20	$770.30
13101 Complicated repair of wound of trunk, 2.6-7.5 cm	69	63	$844.02	$359.13
17314 Removal and microscopic exam of growth of trunk, arms, or legs, each additional stage, 1-5 tissue blocks	68	53	$810.46	$398.10
15120 Skin graft of face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 100 sq cm or less, or 1% body area of infants and children)	50	47	$1800.95	$842.14
88331 Pathology examination of specimen during surgery, first tissue block	44	38	$210.50	$99.58
17004 Destruction of precancer skin growth, 15 or more growths	41	30	$350.57	$168.22
15220 Relocation of patient skin (20 sq centimeters or less) to scalp, arms, and/or legs	37	33	$1607.64	$640.93
13122 Complicated repair of wound of scalp, arms, or legs, each additional 5.0 cm or less	32	32	$282.19	$129.07
14040 Repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet by transferring skin, 10.0 sq cm or less	31	31	$1614.78	$750.26
17110 Destruction of up to 14 skin growths	30	25	$235.58	$105.27
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	30	27	$115.22	$56.67
14302 Repair of wound by transferring skin, each additional 30.0 sq cm	30	23	$487.92	$217.19
15240 Relocation of patient skin to forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet (20 sq centimeters or less)	27	24	$1980.19	$713.63
14021 Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of the scalp, arms, and/or legs	25	25	$1846.98	$844.27
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	25	18	$3.58	$1.08
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	25	21	$266.50	$124.13
11900 Injection into skin growth, 1-7 growths	23	18	$118.01	$48.88
11604 Removal of cancer skin growth of body, arms, or legs, 3.1-4.0 cm	23	22	$667.98	$157.26
14061 Repair of wound of eyelids, nose, ears, or lips by transferring skin, 10.1-30.0 sq cm	22	21	$2153.65	$957.47
13152 Complicated repair of wound of eyelids, nose, ears, or lip, 2.6-7.5 cm	22	22	$1129.85	$251.71
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	21	20	$643.80	$307.85
15576 Creation of flap graft to eyelids, nose, ears, lips, or mouth	17	16	$1709.54	$789.22
69100 Biopsy of ear	16	13	$214.02	$58.05
13102 Complicated repair of wound of trunk, each additional 5.0 cm or less	15	14	$257.10	$118.22
13131 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 1.1-2.5 cm	15	15	$822.74	$236.11
11402 Removal of noncancer skin growth of body, arms, or legs, 1.1-2.0 cm	14	14	$360.38	$87.00
15260 Relocation of patient skin to nose, ears, eyelids, and/or lips (20 sq centimeters or less)	14	14	$2149.00	$971.04
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	13	13	$231.74	$112.74
15630 Transfer of skin flap to eyelids, nose, ears, or lips	12	11	$960.70	$467.81
13133 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, each additional 5.0 cm or less	11	11	$378.32	$169.88

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
J7345 Aminolevulinic acid hcl for topical administration, 10% gel, 10 mg	4,400	22	$2.75	$1.58
17003 Destruction of precancer skin growth, 2-14 growths	704	114	$14.82	$6.81
17311 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, 1-5 tissue blocks	363	292	$1402.83	$490.54
17312 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, each additional stage, 1-5 tissue blocks	353	201	$847.58	$416.68
11102 Tangential biopsy of single skin lesion	245	198	$214.30	$95.38
99213 Established patient office or other outpatient visit, typically 15 minutes	242	194	$187.84	$92.21
11103 Biopsy of related skin growth, each additional growth	203	88	$112.09	$52.59
17000 Destruction of skin growth	176	150	$159.14	$46.87
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	146	146	$231.74	$114.27
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	113	105	$905.62	$284.58
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	108	96	$1167.22	$274.13
17004 Destruction of precancer skin growth, 15 or more growths	96	77	$350.57	$173.49
17313 Removal and microscopic exam of growth of trunk, arms, or legs, 1-5 tissue blocks	71	60	$1311.78	$591.29
17110 Destruction of up to 14 skin growths	54	49	$235.58	$112.47
13101 Complicated repair of wound of trunk, 2.6-7.5 cm	44	36	$844.02	$323.66
17314 Removal and microscopic exam of growth of trunk, arms, or legs, each additional stage, 1-5 tissue blocks	38	31	$810.46	$400.79
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	37	32	$526.52	$126.10
14041 Repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet by transferring skin, 10.1-30.0 sq cm	36	35	$2001.28	$896.76
14060 Repair of wound of eyelids, nose, ears, or lips by transferring skin, 10.0 sq cm or less	36	36	$1646.20	$763.80
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	32	31	$266.50	$130.65
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	29	29	$346.40	$166.88
14040 Repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet by transferring skin, 10.0 sq cm or less	28	28	$1614.78	$764.97
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	28	27	$115.22	$57.85
14301 Repair of wound by transferring skin, 30.1-60.0 sq cm	27	27	$2283.70	$1126.84
14061 Repair of wound of eyelids, nose, ears, or lips by transferring skin, 10.1-30.0 sq cm	23	23	$2153.65	$1016.65
15260 Relocation of patient skin to nose, ears, eyelids, and/or lips (20 sq centimeters or less)	23	23	$2149.00	$997.81
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	22	22	$643.80	$306.38
96567 Application of light and light-sensitive drugs to aid destruction of premalignant skin growths, per session	22	22	$296.84	$148.20
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	21	20	$601.13	$150.43
88331 Pathology examination of specimen during surgery, first tissue block	19	18	$210.50	$102.82
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	19	12	$3.58	$1.14
14021 Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of the scalp, arms, and/or legs	19	18	$1846.98	$891.39
13122 Complicated repair of wound of scalp, arms, or legs, each additional 5.0 cm or less	18	17	$282.19	$132.12
13152 Complicated repair of wound of eyelids, nose, ears, or lip, 2.6-7.5 cm	18	18	$1129.85	$257.94
69100 Biopsy of ear	15	12	$214.02	$56.31
13102 Complicated repair of wound of trunk, each additional 5.0 cm or less	15	14	$257.10	$122.04
15240 Relocation of patient skin to forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet (20 sq centimeters or less)	13	12	$1980.19	$650.79
11604 Removal of cancer skin growth of body, arms, or legs, 3.1-4.0 cm	11	11	$667.98	$160.77

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	437	70	$14.82	$6.51
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	127	127	$231.74	$115.43
11102 Tangential biopsy of single skin lesion	123	118	$214.30	$98.44
17312 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, each additional stage, 1-5 tissue blocks	120	68	$847.58	$418.18
17311 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, 1-5 tissue blocks	115	102	$1402.83	$514.09
11103 Biopsy of related skin growth, each additional growth	109	53	$112.09	$54.64
17000 Destruction of skin growth	92	90	$159.14	$44.47
99213 Established patient office or other outpatient visit, typically 15 minutes	85	79	$187.84	$93.01
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	32	30	$1167.22	$272.42
17004 Destruction of precancer skin growth, 15 or more growths	30	29	$350.57	$171.06
17110 Destruction of up to 14 skin growths	28	26	$235.58	$114.96
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	22	22	$905.62	$256.57
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	18	16	$266.50	$133.25
14060 Repair of wound of eyelids, nose, ears, or lips by transferring skin, 10.0 sq cm or less	17	17	$1646.20	$772.20
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	16	16	$346.40	$173.20
14041 Repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet by transferring skin, 10.1-30.0 sq cm	15	14	$2001.28	$892.75
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	15	14	$526.52	$137.14
17313 Removal and microscopic exam of growth of trunk, arms, or legs, 1-5 tissue blocks	14	12	$1311.78	$561.69
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	13	12	$643.80	$319.76
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	12	12	$115.22	$57.61

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	91	14	$5.95	$5.85
99213 Established patient office or other outpatient visit, typically 15 minutes	35	33	$76.72	$75.52
17000 Destruction of skin growth	22	20	$70.68	$52.16
11100 Biopsy of single growth of skin and/or tissue	14	14	$110.07	$100.57

Medical Specialties & State Licenses

CMS Verified: 2026-01-16

Dermatology Primary Specialty

NUCC Taxonomy Code: 207N00000X

State License NV 20704

A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.

Hospital & Practice Group Affiliations

Mountain West Derm - Blackhart Pllc

3640 Warren Way, Reno, NV 895095240

Phone: 7753240699

Mountain West Derm - Blackhart Pllc

3950 Gs Richards Blvd, Carson City, NV 897038457

Phone: 7758828777

Secondary Practice Locations

3950 Gs Richards Blvd

Carson City, NV 897038457

Phone: 7758828777

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

16 Associated Practitioners

Amber Damonte , PA-C

Physician Assistant

NPI 1063036978

Physician Assistant (Certified)

Dr. Kimberly Kolar , MD

Dermatology

NPI 1144223801

Doctor of Medicine (M.D.)

Dr. Michael Heaphy , MD

Dermatology - Dermatopathology

NPI 1174620496

Doctor of Medicine (M.D.)

Dr. Shaundra Eichstadt , MD

Dermatology

NPI 1174849194

Doctor of Medicine (M.D.)

Dr. Whitney Hovenic , MD

Dermatology - Procedural Dermatology

NPI 1487826764

Doctor of Medicine (M.D.)

Brian Reece , MSN, APRN, FNP-C

Nurse Practitioner - Family

NPI 1568089084

Master of Science in Nursing, Advanced Practice Registered Nurse, Family Nurse Practitioner (Certified)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

9 Historical Events

📍

Updated Practice Location January 16, 2026

Registered at 640 W MOANA LN, RENO, NV 895094903 (Tel: 7753240699)

📍

Updated Business Mailing Address January 16, 2026

Registered at 640 W MOANA LN, RENO, NV 895094903 (Tel: 7753240699)

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) January 16, 2026

Dermatology (License #20704 in NV)

✅

NPI Profile Active June 12, 2014

NPI status registered as active in NPPES database

📍

Updated Practice Location June 12, 2014

Registered at 11234 ANDERSON ST, LOMA LINDA, CA 923542804 (Tel: 9095584074)

📍

Updated Business Mailing Address June 12, 2014

Registered at 11234 ANDERSON ST, GME OFFICE WESTERLY SUITE 'C', LOMA LINDA, CA 923542804 (Tel: 9095584074)

👤

Provider Name / Credentials Updated June 12, 2014

Recorded as MICHAEL ZUMWALT, M.D.

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) June 12, 2014

Student in an Organized Health Care Education/Training Program

🟢

Initial NPI Registration & Enumeration June 12, 2014

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1275947764

Entity Type:

Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)

Enumeration Date: June 12, 2014

Last Update: January 16, 2026

Sole Proprietor: No

Update or Correct Profile

Mailing Address

640 W Moana Ln

Reno, NV 895094903

Phone: 7753240699

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).

⚠️ Medical Disclaimer

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