Provider Demographics
NPI:1235403866
Name:LOS ANGELES CENTER FOR MEDICAL WEIGHT LOSS
Entity Type:Organization
Organization Name:LOS ANGELES CENTER FOR MEDICAL WEIGHT LOSS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:DE SIVLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-726-6255
Mailing Address - Street 1:623 W AVENUE Q
Mailing Address - Street 2:SUITE A
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-3890
Mailing Address - Country:US
Mailing Address - Phone:661-726-6255
Mailing Address - Fax:661-726-6261
Practice Address - Street 1:623 W AVENUE Q
Practice Address - Street 2:SUITE A
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-3890
Practice Address - Country:US
Practice Address - Phone:661-726-6255
Practice Address - Fax:661-726-6261
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DE SILVA MEDICAL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-02-29
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48894132700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes132700000XDietary & Nutritional Service ProvidersDietary ManagerGroup - Single Specialty