MEDICARE: ALPHA MENTAL HEALTH AND WELLNESS, 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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP132438	TX

General Provider Information

NPI Number	:	1366982472
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALPHA MENTAL HEALTH AND WELLNESS, PLLC

Provider Business Mailing Address
First Line	:	11106 BEDAZZLED
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78245-4652
Country	:	US
Telephone Number	:	361-774-0390
Fax Number	:

Provider Business Practice Location Address
First Line	:	1636 LOCKHILL SELMA RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78213-1929
Country	:	US
Telephone Number	:	210-541-8455
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. RICARDO CALDERON
Credential	:	MSN, APRN, PMHNP-BC
Telephone Number	:	361-774-0390

Provider Enumeration Date	:	03/08/2017
Last Update Date	:	03/08/2017

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