| NPI | 1952164063 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALEXANDREA IRENE WALLACE Owner 210-836-7593 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Enumeration Date | 2024-02-01 |
| Last Update Date | 2025-01-27 |