Provider Demographics
NPI:1578978953
Name:SIMPLE WEIGHT LOSS CENTER
Entity Type:Organization
Organization Name:SIMPLE WEIGHT LOSS CENTER
Other - Org Name:SIMPLE WEIGHT LOSS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-834-6970
Mailing Address - Street 1:4120 LYONS AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77020-2538
Mailing Address - Country:US
Mailing Address - Phone:832-834-6970
Mailing Address - Fax:832-834-7189
Practice Address - Street 1:4120 LYONS AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77020-2538
Practice Address - Country:US
Practice Address - Phone:832-834-6970
Practice Address - Fax:832-834-7189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-24
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF0282174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty