Provider Demographics
NPI:1255802278
Name:BIENESTAR INC.
Entity type:Organization
Organization Name:BIENESTAR INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:MS
Authorized Official - First Name:EUNICE
Authorized Official - Middle Name:
Authorized Official - Last Name:ADVINCULA
Authorized Official - Suffix:
Authorized Official - Credentials:CREDENTIALING DEPT
Authorized Official - Phone:562-403-4422
Mailing Address - Street 1:11503 JONES MALTSBERGER RD STE 1106
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-2630
Mailing Address - Country:US
Mailing Address - Phone:210-344-5651
Mailing Address - Fax:210-547-7902
Practice Address - Street 1:11503 JONES MALTSBERGER RD STE 1106
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-2630
Practice Address - Country:US
Practice Address - Phone:210-344-5651
Practice Address - Fax:210-547-7902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Single Specialty