Provider Demographics
NPI:1134677446
Name:PROFESSIONAL WEIGHT CONTROL CENTERS
Entity Type:Organization
Organization Name:PROFESSIONAL WEIGHT CONTROL CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:KAYE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-644-3444
Mailing Address - Street 1:15243 LA CRUZ DR
Mailing Address - Street 2:652
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-3616
Mailing Address - Country:US
Mailing Address - Phone:310-871-3434
Mailing Address - Fax:206-202-4724
Practice Address - Street 1:4601 TELEPHONE RD
Practice Address - Street 2:SUITE 108
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-5670
Practice Address - Country:US
Practice Address - Phone:805-644-3444
Practice Address - Fax:206-202-4724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-15
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG29768207RB0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RB0002XAllopathic & Osteopathic PhysiciansInternal MedicineObesity MedicineGroup - Multi-Specialty