| Vital Life Wellness Center | |
|
2520 Broadway St Suite 100 San Antonio TX 78215-1004 | |
| (210) 595-1019 | |
| (210) 251-3194 |
| Full Name | Vital Life Wellness Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 2520 Broadway St, San Antonio, Texas |
| Authorized Official Name and Position | Bernice Gonzalez (PRESIDENT) |
| Authorized Official Contact | 2105951019 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vital Life Wellness Center 2520 Broadway Street Suite 100 San Antonio TX 78215 Ph: (210) 595-1019 | Vital Life Wellness Center 2520 Broadway St Suite 100 San Antonio TX 78215-1004 Ph: (210) 595-1019 |
| NPI Number | 1184894701 |
|---|---|
| Provider Enumeration Date | 03/11/2008 |
| Last Update Date | 05/08/2013 |
| Medicare PECOS PAC ID | 5698085769 |
|---|---|
| Medicare Enrollment ID | O20151103000520 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184894701 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | J6466 (Texas) | Primary |
| Provider Name | Bernice Gonzalez |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1184622904 PECOS PAC ID: 7810096351 Enrollment ID: I20070623000073 |
| Provider Name | Adrienne W Askew |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1861699456 PECOS PAC ID: 4789749250 Enrollment ID: I20090217000289 |
| Provider Name | Marcela Riojas |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1841456332 PECOS PAC ID: 8325229586 Enrollment ID: I20110221000730 |
| Provider Name | Aimee A Oliver |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1306823505 PECOS PAC ID: 9133164221 Enrollment ID: I20120712000392 |
| Provider Name | Jose O Seda |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1811124993 PECOS PAC ID: 3072759117 Enrollment ID: I20130417000040 |
| Provider Name | Stephanie Thomas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083810972 PECOS PAC ID: 5597907758 Enrollment ID: I20130819000164 |
| Provider Name | Shauna Lyn |
|---|---|
| Provider Type | Practitioner - Preventive Medicine |
| Provider Identifiers | NPI Number: 1437214624 PECOS PAC ID: 7214248038 Enrollment ID: I20150622000363 |
| Provider Name | Jennifer Leigh Perez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437309911 PECOS PAC ID: 8921320409 Enrollment ID: I20150729007528 |
| Provider Name | Nathaniel G Cervantes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003287301 PECOS PAC ID: 0749571636 Enrollment ID: I20160825002354 |
| Provider Name | Dale K Conover |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568904852 PECOS PAC ID: 5496036410 Enrollment ID: I20170106000793 |
| Provider Name | Maria D Ortiz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538603899 PECOS PAC ID: 6204119472 Enrollment ID: I20180122000582 |
| Provider Name | Cristobal G Garcia |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548769052 PECOS PAC ID: 5395008627 Enrollment ID: I20180418002356 |
| Provider Name | Dawn S Olynyk-katan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730673781 PECOS PAC ID: 7810248390 Enrollment ID: I20180921001905 |
| Provider Name | Rochele M Nicolas-wedige |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164750410 PECOS PAC ID: 6507106184 Enrollment ID: I20190318001889 |
| Provider Name | Sherry E Webber |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154985646 PECOS PAC ID: 3274952122 Enrollment ID: I20200928000952 |
| Provider Name | Tiara Davison |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720720071 PECOS PAC ID: 1355615329 Enrollment ID: I20220813000260 |
| Provider Name | Michelle Gray |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336735240 PECOS PAC ID: 7810371838 Enrollment ID: I20220825000141 |
| Provider Name | Jessica L Ruiz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003572207 PECOS PAC ID: 1759685688 Enrollment ID: I20221208000480 |
| Provider Name | Briana Patricia Randolph |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093412900 PECOS PAC ID: 3971977265 Enrollment ID: I20230328003082 |
| Provider Name | Yainer Rodriguez Delgado |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1548898950 PECOS PAC ID: 1153770029 Enrollment ID: I20231218003048 |
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