Provider Demographics
NPI:1417346206
Name:THRIVE WELLNESS CENTER, PLLC
Entity Type:Organization
Organization Name:THRIVE WELLNESS CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALYKHYM
Authorized Official - Middle Name:B
Authorized Official - Last Name:ZARZUELA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-259-8618
Mailing Address - Street 1:17219 OCONNOR RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-5678
Mailing Address - Country:US
Mailing Address - Phone:210-259-8618
Mailing Address - Fax:210-999-5339
Practice Address - Street 1:17219 OCONNOR RD
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78247-5678
Practice Address - Country:US
Practice Address - Phone:210-259-8618
Practice Address - Fax:210-999-5339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-15
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX405999Medicare PIN