Provider Demographics
NPI:1003254533
Name:OLDE NAPLES NUVIVA MEDICAL WEIGHT LOSS INC
Entity Type:Organization
Organization Name:OLDE NAPLES NUVIVA MEDICAL WEIGHT LOSS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-466-4007
Mailing Address - Street 1:201 8TH ST S
Mailing Address - Street 2:103
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-6107
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:201 8TH ST S
Practice Address - Street 2:103
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-6107
Practice Address - Country:US
Practice Address - Phone:239-384-9115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-06
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity MedicineGroup - Multi-Specialty