MEDICARE: ITHRIVE HEALTH & WELLNESS

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	208D00000X	General Practice Physician		TX

General Provider Information

NPI Number	:	1699189415
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ITHRIVE HEALTH & WELLNESS

Provider Business Mailing Address
First Line	:	6009 RICHMOND AVE
Second Line	:	SUITE 115
City	:	HOUSTON
State	:	TX
Zip	:	77057-6226
Country	:	US
Telephone Number	:	888-982-8539
Fax Number	:

Provider Business Practice Location Address
First Line	:	6009 RICHMOND AVE
Second Line	:	SUITE 115
City	:	HOUSTON
State	:	TX
Zip	:	77057-6226
Country	:	US
Telephone Number	:	888-982-8539
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	EVERADO N PEREZ JR.
Credential	:
Telephone Number	:	888-982-8539

Provider Enumeration Date	:	06/19/2014
Last Update Date	:	06/19/2014

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Directions to “ITHRIVE HEALTH & WELLNESS ” Practice Location

Language	Start Address	Practice Location

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