Provider Demographics
NPI:1023898533
Name:PEA IN A POD PSYCHIATRY
Entity type:Organization
Organization Name:PEA IN A POD PSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:DEENA
Authorized Official - Middle Name:
Authorized Official - Last Name:VELAZQUEZ DONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-686-1066
Mailing Address - Street 1:7414 W MAGIC MOUNTAIN LN
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-3482
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:805 W 10TH ST # 400-D
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-2047
Practice Address - Country:US
Practice Address - Phone:512-686-1066
Practice Address - Fax:512-686-1996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty