| Theracare Wellness | |
|
265 S Randolph Ave Ste 120 Brea CA 92821-5798 | |
| (562) 448-5907 | |
| Not Available |
| Full Name | Theracare Wellness |
|---|---|
| Speciality | Psychologist |
| Location | 265 S Randolph Ave Ste 120, Brea, California |
| Authorized Official Name and Position | Dustin Arnold (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 6572463075 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Theracare Wellness 265 S Randolph Ave. Ste 120 Brea CA 92821-5798 Ph: () - | Theracare Wellness 265 S Randolph Ave Ste 120 Brea CA 92821-5798 Ph: (562) 448-5907 |
| NPI Number | 1487200515 |
|---|---|
| Provider Enumeration Date | 08/14/2019 |
| Last Update Date | 09/07/2022 |
| Certification Date | 09/07/2022 |
| Medicare PECOS PAC ID | 9537593371 |
|---|---|
| Medicare Enrollment ID | O20200102001478 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487200515 | NPI | - | NPPES |
| 215E40TL | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Primary |
| Provider Name | Ashley D Prueitt |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1548598220 PECOS PAC ID: 6608187190 Enrollment ID: I20150624003293 |
| Provider Name | Veronica Regueiro |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1003319104 PECOS PAC ID: 3375808454 Enrollment ID: I20180518001567 |
| Provider Name | Alicia Erika Dominguez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1306241435 PECOS PAC ID: 1456601772 Enrollment ID: I20180907001715 |
| Provider Name | Dustin M Arnold |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1366921900 PECOS PAC ID: 1153674239 Enrollment ID: I20181019002315 |
| Provider Name | Catherine Jameson Kelly |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1225463409 PECOS PAC ID: 4284966615 Enrollment ID: I20191104001979 |
| Provider Name | Jehan Helmi |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1497986285 PECOS PAC ID: 7719210517 Enrollment ID: I20191126002893 |
| Provider Name | Elizabeth C Cazares |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1275199903 PECOS PAC ID: 6608209283 Enrollment ID: I20191212002165 |
| Provider Name | Ayat O Madi |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1003399874 PECOS PAC ID: 9032516752 Enrollment ID: I20210923000575 |
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