Provider Demographics
NPI:1558898205
Name:FAMILY MEDICINE & WEIGHT MANAGEMENT SPECIALTY PLLC
Entity Type:Organization
Organization Name:FAMILY MEDICINE & WEIGHT MANAGEMENT SPECIALTY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-343-7911
Mailing Address - Street 1:PO BOX 784
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85366-2335
Mailing Address - Country:US
Mailing Address - Phone:928-343-7911
Mailing Address - Fax:928-343-9528
Practice Address - Street 1:888 W 16TH ST
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-4542
Practice Address - Country:US
Practice Address - Phone:928-550-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-12
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty