Provider Demographics
NPI:1114654902
Name:DIABETES & WEIGHT LOSS CENTER LLC
Entity Type:Organization
Organization Name:DIABETES & WEIGHT LOSS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:
Authorized Official - First Name:ADRIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:407-890-1876
Mailing Address - Street 1:1410 W BROADWAY ST STE 203
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-6472
Mailing Address - Country:US
Mailing Address - Phone:407-890-1876
Mailing Address - Fax:888-498-4294
Practice Address - Street 1:1410 W BROADWAY ST STE 203
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-6472
Practice Address - Country:US
Practice Address - Phone:407-865-2716
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-02
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty