Provider Demographics
NPI:1518379338
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:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LORRAINE
Authorized Official - Middle Name:H
Authorized Official - Last Name:MANCIET
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-744-3952
Mailing Address - Street 1:8275 N SILVERBELL RD STE 113
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85743-5307
Mailing Address - Country:US
Mailing Address - Phone:520-744-3952
Mailing Address - Fax:520-744-2860
Practice Address - Street 1:8275 N SILVERBELL RD STE 113
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85743-5307
Practice Address - Country:US
Practice Address - Phone:520-744-3952
Practice Address - Fax:520-744-2860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-28
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ43719390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty