Provider Demographics
NPI:1184022683
Name:MEDI WEIGHT LOSS
Entity Type:Organization
Organization Name:MEDI WEIGHT LOSS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZEPEDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-596-4014
Mailing Address - Street 1:15577 N HAYDEN RD
Mailing Address - Street 2:#106
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-1958
Mailing Address - Country:US
Mailing Address - Phone:480-596-4014
Mailing Address - Fax:
Practice Address - Street 1:15577 N HAYDEN RD
Practice Address - Street 2:#106
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-1958
Practice Address - Country:US
Practice Address - Phone:480-596-4014
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-15
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP5642363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty