MEDICARE: THRIVE WELLNESS CENTER, 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	363LF0000X	Family Nurse Practitioner
2	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1417346206
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THRIVE WELLNESS CENTER, PLLC

Provider Business Mailing Address
First Line	:	17219 OCONNOR RD
Second Line	:	SUITE 101
City	:	SAN ANTONIO
State	:	TX
Zip	:	78247-5678
Country	:	US
Telephone Number	:	210-259-8618
Fax Number	:	210-999-5339

Provider Business Practice Location Address
First Line	:	17219 OCONNOR RD
Second Line	:	SUITE 101
City	:	SAN ANTONIO
State	:	TX
Zip	:	78247-5678
Country	:	US
Telephone Number	:	210-259-8618
Fax Number	:	210-999-5339

Authorized Official
Title or Position	:	OWNER
Name	:	ALYKHYM B ZARZUELA
Credential	:
Telephone Number	:	210-259-8618

Provider Enumeration Date	:	01/15/2015
Last Update Date	:	07/01/2015

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