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General NPI Number Information
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NPI Number | 1023898533
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Entity Type | Organization
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Legal Business Name | PEA IN A POD PSYCHIATRY
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Dates
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Enumeration Date | 10/02/2023
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Last Update Date | 10/02/2023
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Provider Practice Location Address
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Address Line | 805 W 10TH ST # 400-D
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City | AUSTIN
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State | TX
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Zip | 78701-2047
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Country | US
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Telephone | 512-686-1066
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Fax | 512-686-1996
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Provider Business Mailing Address
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Address Line | 7414 W MAGIC MOUNTAIN LN
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City | ROUND ROCK
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State | TX
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Zip | 78681-3482
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | DEENA VELAZQUEZ DONG
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Credential |
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Telephone | 512-686-1066
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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