Provider Demographics
NPI:1003203035
Name:PROFESSIONAL WEIGHT LOSS FITNESS CENTERS
Entity Type:Organization
Organization Name:PROFESSIONAL WEIGHT LOSS FITNESS CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:WEIGHT LOSS FITNESS MANAGEMENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ADOLFO
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:ALIRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-437-0345
Mailing Address - Street 1:2009 PORTER FIELD WAY STE H
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-1106
Mailing Address - Country:US
Mailing Address - Phone:909-981-3509
Mailing Address - Fax:
Practice Address - Street 1:2009 PORTER FIELD WAY STE H
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-1106
Practice Address - Country:US
Practice Address - Phone:909-981-3509
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-16
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty