Provider Demographics
NPI:1376805101
Name:LIFE STYLE MODIFICATION,INC.
Entity Type:Organization
Organization Name:LIFE STYLE MODIFICATION,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRSEDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ATTAI
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:805-409-3000
Mailing Address - Street 1:2393 TOWNSGATE RD STE 102
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-2513
Mailing Address - Country:US
Mailing Address - Phone:805-409-3000
Mailing Address - Fax:805-409-3001
Practice Address - Street 1:2393 TOWNSGATE RD STE 102
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-2513
Practice Address - Country:US
Practice Address - Phone:805-409-3000
Practice Address - Fax:805-409-3001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care