# PEAK WELLNESS PSYCHIATRY, A PROFESSIONAL NURSING CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1376184168
- **Authorized official:** RYAN D THEBO PMHNP-BC (OWNER OF ENTITY)
- **Authorized official phone:** (888) 909-8676

## Contact information

- **Practice address:** 8880 RIO SAN DIEGO DR STE 800, SAN DIEGO, CA 92108-1642
- **Practice address phone:** (888) 909-8676
- **Mailing address:** 440 N BARRANCA AVE \# 6619, COVINA, CA 91723-1722
- **Mailing address phone:** (888) 909-8676
- **Mailing address fax:** (855) 940-1848

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2084P0800X | Psychiatry Physician | — | NULL | — |
| 2084P0800X | Psychiatry Physician | — | — | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 10/02/2019
- **Last updated:** 07/06/2023