Provider Demographics
NPI:1376886861
Name:WELLNESS MENTAL HEALTH CARE PA
Entity Type:Organization
Organization Name:WELLNESS MENTAL HEALTH CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NIKAURY
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA-ANTONGIORGI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-378-0017
Mailing Address - Street 1:5219 MCPHERSON RD
Mailing Address - Street 2:SUITE 417
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-7306
Mailing Address - Country:US
Mailing Address - Phone:956-523-0680
Mailing Address - Fax:956-523-0837
Practice Address - Street 1:5219 MCPHERSON RD
Practice Address - Street 2:SUITE 417
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041
Practice Address - Country:US
Practice Address - Phone:956-523-0680
Practice Address - Fax:956-523-0837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-03
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP2772261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health