Provider Demographics
NPI:1952723991
Name:PROFESSIONAL MIND WELLNESS CENTER, P.A.
Entity Type:Organization
Organization Name:PROFESSIONAL MIND WELLNESS CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YAHAIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:ESPADA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-621-0587
Mailing Address - Street 1:26 S CORIA ST
Mailing Address - Street 2:B-2
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-7565
Mailing Address - Country:US
Mailing Address - Phone:956-621-0587
Mailing Address - Fax:956-621-0595
Practice Address - Street 1:26 S CORIA ST
Practice Address - Street 2:B-2
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-7565
Practice Address - Country:US
Practice Address - Phone:956-621-0587
Practice Address - Fax:956-621-0595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-10
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN83942084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty