1700310596 NPI number — WEIGHT LIFE MEDICAL CENTER LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700310596 NPI number — WEIGHT LIFE MEDICAL CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WEIGHT LIFE MEDICAL CENTER LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700310596
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/18/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8370 W FLAGLER ST
Provider Second Line Business Mailing Address:
SUITE 240
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33144-2094
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
786-332-2504
Provider Business Mailing Address Fax Number:
786-332-2586

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8370 W FLAGLER ST
Provider Second Line Business Practice Location Address:
SUITE 240
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33144-2094
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
786-332-2504
Provider Business Practice Location Address Fax Number:
786-332-2586
Provider Enumeration Date:
04/18/2017

Additional Information

Authorized Official

Authorized Official Last Name:
ESPINOSA
Authorized Official First Name:
GILBERTO
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
786-332-2504

Provider Taxonomy Codes

  • Taxonomy code: 261QR0400X , with the licence number:  HCC12511 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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