Provider Demographics
NPI:1891784161
Name:LATINO MEDICAL AND WEIGHT LOSS CENTER PROFESSIONAL ASSOCIATION
Entity Type:Organization
Organization Name:LATINO MEDICAL AND WEIGHT LOSS CENTER PROFESSIONAL ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:HUGO
Authorized Official - Last Name:RON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-620-9895
Mailing Address - Street 1:8 MEDICAL PKWY
Mailing Address - Street 2:SUITE 301
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75234-7859
Mailing Address - Country:US
Mailing Address - Phone:972-620-9895
Mailing Address - Fax:972-620-0382
Practice Address - Street 1:8 MEDICAL PKWY
Practice Address - Street 2:SUITE 301
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75234-7859
Practice Address - Country:US
Practice Address - Phone:972-620-9895
Practice Address - Fax:972-620-9895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-19
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX143324501Medicaid