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NPI Code Detail

MEDICARE: PEAK WELLNESS PSYCHIATRY, A PROFESSIONAL NURSING CORPORATION

MEDICARE: PEAK WELLNESS PSYCHIATRY, A PROFESSIONAL NURSING CORPORATION
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
12084P0800XPsychiatry Physician
2363LP0808XPsychiatric/Mental Health Nurse Practitioner

General Provider Information

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

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Directions to “PEAK WELLNESS PSYCHIATRY, A PROFESSIONAL NURSING CORPORATION ” Practice Location

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