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General NPI Number Information
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NPI Number | 1912543968
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Entity Type | Organization
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Legal Business Name | PRIDE MEDICAL SPA AND WELLNESS CENTER INC
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Dates
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Enumeration Date | 11/25/2019
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Last Update Date | 08/27/2020
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Provider Practice Location Address
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Address Line | 5365 MAE ANNE AVE STE A10
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City | RENO
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State | NV
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Zip | 89523-1841
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Country | US
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Telephone | 775-432-1500
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Fax | 775-432-1002
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Provider Business Mailing Address
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Address Line | 5365 MAE ANNE AVE STE A10
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City | RENO
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State | NV
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Zip | 89523-1841
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Country | US
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Telephone | 775-432-1500
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Fax | 775-432-1002
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Authorized Official
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Title or Position | CLINIC DIRECTOR
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Name | MR. GREG JONES
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Credential | CRNA, MS, BSN
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Telephone | 775-217-0332
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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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