PEAK WELLNESS PSYCHIATRY, A PROFESSIONAL NURSING CORPORATION (NPI# 1376184168) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1376184168 |
| Entity Type | Organization |
| Organization Name | PEAK WELLNESS PSYCHIATRY, A PROFESSIONAL NURSING CORPORATION |
| Practice Address |
2667 Camino Del Rio S Ste 301-8 San Diego CA 92108-3707 |
| Mailing Address |
3625 Earnscliff Pl Apt 20 San Diego CA 92111-4159 |
| Practice Telephone | 6193636570 |
| Mailing Telephone | 6193636570 |
| Enumeration Date | 2019-10-02 |
| Last Update Date | 2019-12-03 |
| Authorized Official Name | RYAN D THEBO (OWNER OF ENTITY) |
| Authorized Official Telephone | 6193636570 |
| Authorized Official Credential | PMHNP-BC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
2667 CAMINO DEL RIO S STE 301-8 |
| City | SAN DIEGO |
| State | CA |
| Zip Code | 92108-3707 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043761141 | Ryan Thebo | Nurse Practitioner | 2667 Camino Del Rio S Ste 301-8, San Diego, CA 92108-3707 | 2016-10-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952902801 | Keri Castaneda | Behavior Technician | 025 Camino Del Rio South Suite 101, San Diego, CA 92108 | 2020-11-06 |
| 1457963738 | Diyana Giorgees | Case Manager/Care Coordinator | 5005 Texas Street, St. 203, San Diego, CA 92108 | 2020-08-19 |
| 1780211896 | Lori Mildred Jerman | Marriage & Family Therapist | Healthy Minds Counseling Services, 1455 Frazee Road, Suite 880, San Diego, CA 92108 | 2020-03-26 |
| 1285260737 | Demetrius Anderson | Counselor | Telecare Corporation Ihot, 1660 Hotel Circle North, Suite 101, San Deigo, CA 92108 | 2020-03-17 |
| 1033742465 | Dasc Medical Inc | Durable Medical Equipment & Medical Supplies | 5520 Gill Village Way, 907, San Diego, CA 92108 | 2020-02-13 |
| 1508401092 | Chanda Denee Kizer | Marriage & Family Therapist | 3517 Camino Del Rio N, Suite 407, San Diego, CA 92108 | 2019-11-08 |
| 1225695562 | Jenna Rose Shurer | Nurse Practitioner | 5030 Camino De La Siesla Ste 106, San Diego, CA 92108 | 2019-05-22 |
| 1952967812 | Martha Kebede Mekonen | Chiropractor | 2667 Camino Del Rio South, Suite #313, San Diego, CA 92108 | 2019-05-16 |
| 1053886135 | Andrea Jiselly Munoz | Behavior Technician | 3505 Camino Del Rio South, Suite 200, San Diego, CA 92108 | 2018-10-04 |
| 1386128916 | Sarah Elisabeth Smith | Counselor | 7575 Metropolitan Dr., San Diego, CA 92108 | 2018-09-19 |
| Find all providers in zip 92108 | ||||
| Taxonomy Code | 363LP0808X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609431196 | Tanya Denise Stevenson-gaines | Nurse Practitioner | 13988 Royal Melbourne Sq, San Diego, CA 92128-3646 | 2019-05-09 |
| 1457788598 | Christopher John Reddin | Nurse Practitioner | Naval Medical Center San Diego C I D, 34800 Bob Wilson Drive, San Diego, CA 92134-0001 | 2013-10-03 |
| 1356650634 | Jamie M Sorenson | Nurse Practitioner | Center Star Act Mental Health Systems, 4283 El Cajon Blvd, Suite 115, San Diego, CA 92105-0001 | 2010-10-04 |
| 1023345204 | Nelda K. Coleman | Nurse Practitioner | 4715 Viewridge Avenue, Suite 230, San Diego, CA 92123 | 2009-11-10 |
| 1972506483 | Steven G Hogan | Nurse Practitioner | 8810 Rio San Diego Dr, San Diego, CA 92108-1698 | 2005-05-30 |
| 1396358024 | Stephanie Joyce Reed | Nurse Practitioner | 2630 1st Ave, San Diego, CA 92103-6599 | 2020-08-24 |
| 1104442185 | Joshua Don Dougherty | Nurse Practitioner | 1550 Hotel Cir N Ste 450, San Diego, CA 92108-2933 | 2020-06-24 |
| 1801422258 | Safiya Damali Daley | Nurse Practitioner | 1675 Morena Blvd, San Diego, CA 92110-3703 | 2020-03-17 |
| 1083247779 | Fernando Ebeo Serrano Jr. | Nurse Practitioner | 3491 Kurtz St Ste 150, San Diego, CA 92110-4430 | 2020-02-20 |
| 1538790605 | Kat Tupas Balingit | Nurse Practitioner | 140 Arbor Dr, San Diego, CA 92103-2007 | 2020-01-28 |
| Find all providers in SAN DIEGO | ||||
Please comment or provide details below to improve the information on PEAK WELLNESS PSYCHIATRY, A PROFESSIONAL NURSING CORPORATION.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.