Provider Demographics
NPI:1538507066
Name:FORT MYERS NUVIVA MEDICAL WEIGHT LOSS INC
Entity Type:Organization
Organization Name:FORT MYERS NUVIVA MEDICAL WEIGHT LOSS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-466-4007
Mailing Address - Street 1:13450 PARKER COMMONS BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-1810
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13450 PARKER COMMONS BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-1810
Practice Address - Country:US
Practice Address - Phone:239-466-4007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-06
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RB0002XAllopathic & Osteopathic PhysiciansInternal MedicineObesity MedicineGroup - Multi-Specialty
No207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity MedicineGroup - Multi-Specialty