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General NPI Number Information
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NPI Number | 1376184168
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Entity Type | Organization
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Legal Business Name | PEAK WELLNESS PSYCHIATRY, A PROFESSIONAL NURSING CORPORATION
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Dates
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Enumeration Date | 10/02/2019
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Last Update Date | 07/06/2023
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Provider Practice Location Address
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Address Line | 8880 RIO SAN DIEGO DR STE 800
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City | SAN DIEGO
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State | CA
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Zip | 92108-1642
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Country | US
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Telephone | 888-909-8676
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Fax |
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Provider Business Mailing Address
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Address Line | 440 N BARRANCA AVE # 6619
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City | COVINA
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State | CA
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Zip | 91723-1722
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Country | US
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Telephone | 888-909-8676
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Fax | 855-940-1848
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Authorized Official
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Title or Position | OWNER OF ENTITY
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Name | RYAN D THEBO
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Credential | PMHNP-BC
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Telephone | 888-909-8676
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #2
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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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