Provider Demographics
NPI:1669298873
Name:PRIDE HEALTH & WELLNESS SOLUTIONS
Entity type:Organization
Organization Name:PRIDE HEALTH & WELLNESS SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIAN
Authorized Official - Middle Name:RAMIREZ
Authorized Official - Last Name:BAUTISTA-DE-LEON
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:561-309-4434
Mailing Address - Street 1:633 S ESTRELLA PKWY STE 3-120
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-9331
Mailing Address - Country:US
Mailing Address - Phone:623-306-7200
Mailing Address - Fax:855-576-5012
Practice Address - Street 1:633 S ESTRELLA PKWY STE 3-120
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-9331
Practice Address - Country:US
Practice Address - Phone:623-306-7200
Practice Address - Fax:855-576-5012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-03
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty