| Holly Psychiatric Clinic Pllc | |
|
4444 Corona Dr Ste 150 Corpus Christi TX 78411-4300 | |
| (361) 993-4835 | |
| (361) 993-7043 |
| Full Name | Holly Psychiatric Clinic Pllc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 4444 Corona Dr Ste 150, Corpus Christi, Texas |
| Authorized Official Name and Position | Mario A Quintanilla (MEDICAL DIRECTOR) |
| Authorized Official Contact | 3619934835 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Holly Psychiatric Clinic Pllc 4444 Corona Dr Ste 150 Corpus Christi TX 78411-4300 Ph: (361) 993-4835 | Holly Psychiatric Clinic Pllc 4444 Corona Dr Ste 150 Corpus Christi TX 78411-4300 Ph: (361) 993-4835 |
| NPI Number | 1518465079 |
|---|---|
| Provider Enumeration Date | 01/30/2018 |
| Last Update Date | 03/28/2023 |
| Certification Date | 03/28/2023 |
| Medicare PECOS PAC ID | 9537554456 |
|---|---|
| Medicare Enrollment ID | O20220311000499 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518465079 | NPI | - | NPPES |
| 451455601 | Medicaid | TX | |
| 2B0918 | Other | TX | MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| 363LF0000X | Nurse Practitioner - Family | (* (Not Available)) | Secondary |
| Provider Name | Mario A Quintanilla |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1871552729 PECOS PAC ID: 0244402303 Enrollment ID: I20111013000541 |
| Provider Name | Edna B Kimanga |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245638212 PECOS PAC ID: 8628397056 Enrollment ID: I20150506000159 |
| Provider Name | Tiffany Adela Sanchez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518444090 PECOS PAC ID: 8325437726 Enrollment ID: I20211104002528 |
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