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Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

VITALIS WOUND CARE LLC
NPI 1417745936
Nurse Practitioner in Las Vegas, NV

Active since April 25, 2025
3062 CONQUISTA CT, LAS VEGAS, NV 89121(702) 673-1930 Get Directions Write a Review

NPPES record last updated: September 22, 2026. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Vitalis Wound Care Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

VITALIS WOUND CARE LLC (NPI 1417745936) is a healthcare organization registered as a nurse practitioner in Las Vegas, Nevada and active in the NPI registry since April 2025. The organization maintains a secondary practice location in Chicago and lists William Dela Paz, Owner, as its authorized official.

NPPES Registry Identity

NPI1417745936
Entity TypeOrganization
Primary Taxonomy363L00000X
Legal Business NameVITALIS WOUND CARE LLC
Location Address3062 CONQUISTA CTLas Vegas, NV 89121-3829
Mailing Address3062 Conquista CtLas Vegas, NV 89121-3829
Phone(702) 673-1930
Organization SubpartNo
Authorized OfficialWilliam Dela PazOwner · (909) 910-2804
Enumeration DateApril 25, 2025
Last NPPES UpdateSeptember 22, 2026
NPPES CertifiedSeptember 22, 2026
✔ NPI 1417745936 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363L00000X
Definition
(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.
Also ListedInternal MedicineTaxonomy 207R00000X
3062 CONQUISTA CT, Las Vegas, NV 89121
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Secondary Practice Location 1

Location 16033 N Kedzie Ave # 2Chicago, IL 60659-2406 · Phone (702) 673-1930 · Fax (702) 974-3559

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Vitalis Wound Care Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

2

Medicare enrollment records show 2 clinicians reassign Medicare billing to Vitalis Wound Care LLC, which bills Medicare for the services they deliver. Of these, 1 practice within 10 miles. They are listed nearest first.

Clinicians, nearest first (2)

Gerald Gibbs, APRN
Nurse Practitioner
NPI 1700441094
2820 W CHARLESTON BLVD STE 36
Las Vegas, NV 89102
(702) 665-9815
✔ PECOS✔ Accepts Medicare4.8 mi
Raymond Tinio, NP
Nurse Practitioner
NPI 1033751938
829 N LA CADENA DR
Colton, CA 92324
(562) 310-5772
✔ PECOS190 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Vitalis Wound Care LLC's NPI number?

The NPI number for Vitalis Wound Care LLC is 1417745936. It was assigned to this organization in the NPPES registry on April 25, 2025.

Where is Vitalis Wound Care LLC located?

Vitalis Wound Care LLC is located at 3062 Conquista Ct, Las Vegas, NV 89121. The listed phone number is (702) 673-1930.

What is Vitalis Wound Care LLC's specialty?

The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.

Is Vitalis Wound Care LLC enrolled in Medicare?

Yes. Vitalis Wound Care LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Vitalis Wound Care LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians, all in Nurse Practitioner, reassign their Medicare billing to Vitalis Wound Care LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 1 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Vitalis Wound Care LLC was last updated on September 22, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 30 days ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.