| New Leaf Wellness Center | |
|
10921 Pellicano Dr Ste 110 El Paso TX 79935 | |
| (915) 313-4114 | |
| (915) 313-4939 |
| Full Name | New Leaf Wellness Center |
|---|---|
| Speciality | Counselor |
| Location | 10921 Pellicano Dr Ste 110, El Paso, Texas |
| Authorized Official Name and Position | Noe Antonio Lopez (CEO) |
| Authorized Official Contact | 9153134114 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| New Leaf Wellness Center 10921 Pellicano Dr Ste 110 El Paso TX 79935-4604 Ph: (915) 313-4114 | New Leaf Wellness Center 10921 Pellicano Dr Ste 110 El Paso TX 79935 Ph: (915) 313-4114 |
| NPI Number | 1366796724 |
|---|---|
| Provider Enumeration Date | 11/06/2012 |
| Last Update Date | 09/01/2021 |
| Certification Date | 09/01/2021 |
| Medicare PECOS PAC ID | 8426411471 |
|---|---|
| Medicare Enrollment ID | O20230824001129 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366796724 | NPI | - | NPPES |
| 3898868 | Medicaid | TX | |
| 2915829 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 66155 (Texas) | Primary |
| Provider Name | Martin Guerrero |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1952591935 PECOS PAC ID: 6002894094 Enrollment ID: I20040707001203 |
| Provider Name | Bettina Ritzi Lopez Cordova |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992204853 PECOS PAC ID: 4082942420 Enrollment ID: I20190823000965 |
| Provider Name | Dulce Carolina Senclair |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215697404 PECOS PAC ID: 2264828441 Enrollment ID: I20220418000042 |
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