Provider Demographics
NPI:1225881345
Name:WELLNESSA LLC
Entity Type:Organization
Organization Name:WELLNESSA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:VARGAS
Authorized Official - Suffix:
Authorized Official - Credentials:MDS, RDN, LD
Authorized Official - Phone:210-872-5176
Mailing Address - Street 1:503 AVENUE A APT 1117
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78215-1272
Mailing Address - Country:US
Mailing Address - Phone:210-872-5176
Mailing Address - Fax:
Practice Address - Street 1:503 AVENUE A APT 1117
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78215-1272
Practice Address - Country:US
Practice Address - Phone:210-872-5176
Practice Address - Fax:855-620-6876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty