Provider Demographics
NPI:1366217515
Name:MI GENTE HEALTH N WELLNESS LLC
Entity type:Organization
Organization Name:MI GENTE HEALTH N WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICIO
Authorized Official - Middle Name:ELIAS
Authorized Official - Last Name:RIESGO
Authorized Official - Suffix:
Authorized Official - Credentials:BHT
Authorized Official - Phone:520-392-0854
Mailing Address - Street 1:7643 W TIGHT LINE DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85757-1619
Mailing Address - Country:US
Mailing Address - Phone:520-392-0854
Mailing Address - Fax:
Practice Address - Street 1:7643 W TIGHT LINE DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85757-1619
Practice Address - Country:US
Practice Address - Phone:520-392-0854
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-17
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health