Provider Demographics
NPI:1851115398
Name:SIA'S PLACE WELLNESS CENTER
Entity type:Organization
Organization Name:SIA'S PLACE WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SIA
Authorized Official - Middle Name:
Authorized Official - Last Name:XIONG-LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-515-1696
Mailing Address - Street 1:151 N VILLA AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-3257
Mailing Address - Country:US
Mailing Address - Phone:559-515-1696
Mailing Address - Fax:
Practice Address - Street 1:151 N VILLA AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-3257
Practice Address - Country:US
Practice Address - Phone:559-515-1696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No251B00000XAgenciesCase Management
No251K00000XAgenciesPublic Health or Welfare
No251V00000XAgenciesVoluntary or Charitable
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty