Organization
TULAYA WELLNESS CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GINA NEGRETTE MD (OWNER)
(262) 751-3730
Entity
Organization
Contact information
Practice address
6789 N GREEN BAY AVE, GLENDALE, WI 53209-3472
(262) 751-3730
Mailing address
345 W RAVINE BAYE RD, BAYSIDE, WI 53217-1336
(262) 751-3730
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
5214820
WI
Other
Enumeration date
04/07/2016
Last updated
04/07/2016
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