Organization
WELLINGTON PROVIDER GROUP, PC
Active
Parent organization
WELLINGTON PROVIDER GROUP, PC
Organization subpart
Yes
Provider details
NPI number
Legal business name
WELLINGTON PROVIDER GROUP, PC
Authorized official
MARIELA BRAVO (CREDENTIALING TEAM LEAD)
(831) 313-6799
Entity
Organization
Contact information
Practice address
10260 SW GREENBURG RD FL 4, PORTLAND, OR 97223-5500
(859) 439-0400
Mailing address
535 WELLINGTON WAY STE 330, LEXINGTON, KY 40503-1331
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
12/19/2022
Last updated
12/19/2022
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