Provider Demographics
NPI:1023999208
Name:RISEUP PERFORMANCE AND WELLNESS LLC
Entity type:Organization
Organization Name:RISEUP PERFORMANCE AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CLARISSA
Authorized Official - Middle Name:ARGUELLES
Authorized Official - Last Name:MEDRANO
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:915-342-3360
Mailing Address - Street 1:6716 CRUCERO DEL SOL
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79911-3022
Mailing Address - Country:US
Mailing Address - Phone:619-494-9099
Mailing Address - Fax:
Practice Address - Street 1:6716 CRUCERO DEL SOL
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79911-3022
Practice Address - Country:US
Practice Address - Phone:619-494-9099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-11
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty