Wisteria Mental Health & Wellness Center PLLC
NPI 1194413419ActiveOrganization· Psychiatry & Neurology, Child & Adolescent Psychiatry· Phoenix, AZ
Psychiatry & Neurology, Child & Adolescent Psychiatry in Phoenix, Arizona, registered in NPPES in April 2023. The authorized official on file is Roberto Igor Bracamonte Valencia, MD, Ceo.
Overview
| NPI | 1194413419 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Apr 25, 2023 |
| Last updated in NPPES | Mar 14, 2025 |
| Certified by provider | Mar 14, 2025 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Psychiatry & Neurology, Child & Adolescent Psychiatry Primary | 2084P0804X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Not in the public enrollment file of Oct 1, 2026 |
|---|
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