Provider Demographics
NPI:1619322823
Name:MEDI-WEIGHTLOSS CLINIC OF JUPITER
Entity Type:Organization
Organization Name:MEDI-WEIGHTLOSS CLINIC OF JUPITER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:DELUCIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-776-5252
Mailing Address - Street 1:4600 MILITARY TRL STE 111
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-4811
Mailing Address - Country:US
Mailing Address - Phone:561-776-5820
Mailing Address - Fax:
Practice Address - Street 1:4600 MILITARY TRL
Practice Address - Street 2:SUITE 114
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-4810
Practice Address - Country:US
Practice Address - Phone:561-776-5252
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-26
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1528462454OtherNPI NUMBER CABRINI FARANO
FL1528462454OtherNPI EMELY WINCHESTER
FL10033835604OtherNPI NUMBER RICHARD DELUCIA MD
FL1407845613OtherNPI NUMBER DANA BILNOSKI, DO
FL1417335456OtherNPI NUMBER AMANDA CORDKING, APRN