Organization
MEDPSYCH WELLNESS PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EDGAR SAMUEL MEDINA MD (MANAGER)
(818) 415-7968
Entity
Organization
Contact information
Practice address
5282 MEDICAL DR STE 605, SAN ANTONIO, TX 78229-6114
(210) 908-6337
Mailing address
19141 STONE OAK PARKWAY SUITE 104, PMB 217, SAN ANTONIO, TX 78258-3367
(210) 908-6337
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1598045981
NATIONAL PLAN & PROVIDER ENUMERATION SYSTEM
—
Enumeration date
04/03/2020
Last updated
04/03/2020
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