Healthcare Provider Details

I. General information

NPI: 1558890996
Provider Name (Legal Business Name): AURELIA RICKETTS PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AURELIA WUELFING

II. Dates (important events)

Enumeration Date: 06/08/2017
Last Update Date: 06/06/2023
Certification Date: 06/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 N MADISON AVE
PASADENA CA
91101-1710
US

IV. Provider business mailing address

102 N MADISON AVE
PASADENA CA
91101-1710
US

V. Phone/Fax

Practice location:
  • Phone: 626-602-8530
  • Fax: 626-597-3336
Mailing address:
  • Phone: 626-602-8530
  • Fax: 626-597-3336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number849378
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number95144709
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95008067
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: