Provider Demographics
NPI:1265835599
Name:L MANCIET MD, PHD AND ASSOCIATES MEDICAL WEIGHT LOSS
Entity Type:Organization
Organization Name:L MANCIET MD, PHD AND ASSOCIATES MEDICAL WEIGHT LOSS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LORRAINE
Authorized Official - Middle Name:HANNA
Authorized Official - Last Name:MANCIET
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:520-744-7496
Mailing Address - Street 1:8553 N SILVERBELL RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85743-9513
Mailing Address - Country:US
Mailing Address - Phone:520-744-7496
Mailing Address - Fax:520-744-8008
Practice Address - Street 1:8553 N SILVERBELL RD
Practice Address - Street 2:SUITE 101
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85743-9513
Practice Address - Country:US
Practice Address - Phone:520-744-7496
Practice Address - Fax:520-744-8008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-01
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ43719261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ167437Medicare PIN