Provider Demographics
NPI:1043601412
Name:ADVANCED WEIGHT LOSS SURGICAL ASSOCIATES INC
Entity Type:Organization
Organization Name:ADVANCED WEIGHT LOSS SURGICAL ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FEIZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-855-8058
Mailing Address - Street 1:9663 SANTA MONICA BLVD
Mailing Address - Street 2:#294
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4303
Mailing Address - Country:US
Mailing Address - Phone:310-855-8058
Mailing Address - Fax:310-855-5059
Practice Address - Street 1:435 N ROXBURY DR
Practice Address - Street 2:STE 100
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-5027
Practice Address - Country:US
Practice Address - Phone:310-855-8058
Practice Address - Fax:310-855-8059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-06
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79543208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty