Provider Demographics
NPI:1417685181
Name:HEAL MEDICAL WEIGHT LOSS CLINIC CORP.
Entity Type:Organization
Organization Name:HEAL MEDICAL WEIGHT LOSS CLINIC CORP.
Other - Org Name:HEAL PSYCHIATRIC SERVICES, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FARZANA
Authorized Official - Middle Name:
Authorized Official - Last Name:AMIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-629-7696
Mailing Address - Street 1:1710 S AMPHLETT BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-2715
Mailing Address - Country:US
Mailing Address - Phone:650-273-4082
Mailing Address - Fax:650-275-7559
Practice Address - Street 1:1710 S AMPHLETT BLVD STE 250
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-2715
Practice Address - Country:US
Practice Address - Phone:650-273-4082
Practice Address - Fax:650-275-7559
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEAL PSYCHIATRIC SERVICES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-08-10
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
No2084B0002XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyObesity MedicineGroup - Multi-Specialty