| NPI | 1043922321 |
|---|---|
| Doing Business As | WELLINGTON PROVIDER GROUP PC |
| Entity Type | Organization |
| Authorized Contact | MARIELA BRAVO Credentialing Team Lead 859-518-8817 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Enumeration Date | 2022-12-19 |
| Last Update Date | 2022-12-19 |