MEDICARE: WELLNESSA LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1225881345
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLNESSA LLC

Provider Business Mailing Address
First Line	:	503 AVENUE A APT 1117
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78215-1272
Country	:	US
Telephone Number	:	210-872-5176
Fax Number	:

Provider Business Practice Location Address
First Line	:	503 AVENUE A APT 1117
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78215-1272
Country	:	US
Telephone Number	:	210-872-5176
Fax Number	:	855-620-6876

Authorized Official
Title or Position	:	OWNER
Name	:	VANESSA VARGAS
Credential	:	MDS, RDN, LD
Telephone Number	:	210-872-5176

Provider Enumeration Date	:	04/09/2024
Last Update Date	:	04/09/2024

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Directions to “WELLNESSA LLC ” Practice Location

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