Provider Demographics
NPI:1376067215
Name:WONDER WEIGHT LOSS AND WELLNESS CENTER
Entity Type:Organization
Organization Name:WONDER WEIGHT LOSS AND WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP
Authorized Official - Prefix:
Authorized Official - First Name:MERCY
Authorized Official - Middle Name:
Authorized Official - Last Name:ABIDOYE-FAKOYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-999-4306
Mailing Address - Street 1:11665 S HIGHWAY 6
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77498-1302
Mailing Address - Country:US
Mailing Address - Phone:832-999-4306
Mailing Address - Fax:
Practice Address - Street 1:11665 S HIGHWAY 6
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77498-1302
Practice Address - Country:US
Practice Address - Phone:832-999-4306
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-02
Last Update Date:2017-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Multi-Specialty
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty