Provider Demographics
NPI:1598990061
Name:LIFETURN WEIGHT LOSS, LLC
Entity Type:Organization
Organization Name:LIFETURN WEIGHT LOSS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / FOUNDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:CAROLINE
Authorized Official - Last Name:DISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-476-8876
Mailing Address - Street 1:1601 DOVE ST
Mailing Address - Street 2:193
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2433
Mailing Address - Country:US
Mailing Address - Phone:949-476-8876
Mailing Address - Fax:949-476-3028
Practice Address - Street 1:1601 DOVE ST
Practice Address - Street 2:193
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2433
Practice Address - Country:US
Practice Address - Phone:949-476-8876
Practice Address - Fax:949-476-3028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-27
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization