Provider Demographics
NPI:1972369163
Name:AN IDEAL YOU HEALTH AND WELLNESS PLLC
Entity Type:Organization
Organization Name:AN IDEAL YOU HEALTH AND WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:A
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:956-334-3512
Mailing Address - Street 1:9258 CULEBRA RD STE 140-9
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-2871
Mailing Address - Country:US
Mailing Address - Phone:956-334-3512
Mailing Address - Fax:
Practice Address - Street 1:9258 CULEBRA RD STE 140-9
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-2871
Practice Address - Country:US
Practice Address - Phone:956-334-3512
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty