Provider Demographics
NPI:1700213089
Name:DR STINSON'S WEIGHT LOSS PROGRAM
Entity Type:Organization
Organization Name:DR STINSON'S WEIGHT LOSS PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:OLIVARES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-537-9317
Mailing Address - Street 1:801 E FERN AVE
Mailing Address - Street 2:105
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-1496
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:801 E FERN AVE
Practice Address - Street 2:105
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-1496
Practice Address - Country:US
Practice Address - Phone:956-537-9317
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-02
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes132700000XDietary & Nutritional Service ProvidersDietary ManagerGroup - Multi-Specialty