MEDICARE: PROSPERA WELLNES AND PRIMARY CARE PLLC

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1760346795
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROSPERA WELLNES AND PRIMARY CARE PLLC

Provider Business Mailing Address
First Line	:	3914 AZALI DR
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78414-1406
Country	:	US
Telephone Number	:	208-240-7553
Fax Number	:	712-327-7633

Provider Business Practice Location Address
First Line	:	3914 AZALI DR
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78414-1406
Country	:	US
Telephone Number	:	208-240-7553
Fax Number	:	712-327-7633

Authorized Official
Title or Position	:	OWNER
Name	:	LUMA MOHSIN
Credential	:	MD
Telephone Number	:	208-240-7553

Provider Enumeration Date	:	12/13/2025
Last Update Date	:	12/13/2025

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