Provider Demographics
NPI:1255863585
Name:VIVANTE WEIGHT LOSS AND HEALTH
Entity Type:Organization
Organization Name:VIVANTE WEIGHT LOSS AND HEALTH
Other - Org Name:SUCCESS WEIGHT LOSS SYSTEM LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CERTIFIED HEALTH COACH/NUTRITIONIST
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MCINTYRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-433-2674
Mailing Address - Street 1:6911 TAYLOR RANCH RD NW
Mailing Address - Street 2:SUITE C8
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-2963
Mailing Address - Country:US
Mailing Address - Phone:505-433-2674
Mailing Address - Fax:
Practice Address - Street 1:6911 TAYLOR RANCH RD NW
Practice Address - Street 2:SUITE C8
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-2963
Practice Address - Country:US
Practice Address - Phone:505-433-2674
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-27
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Multi-Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty