Provider Demographics
NPI:1952823841
Name:WHOLE HEALTH WEIGHT LOSS INSTITUTE
Entity Type:Organization
Organization Name:WHOLE HEALTH WEIGHT LOSS INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:V
Authorized Official - Last Name:PERRYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-387-5468
Mailing Address - Street 1:PO BOX 594
Mailing Address - Street 2:
Mailing Address - City:SONOMA
Mailing Address - State:CA
Mailing Address - Zip Code:95476-0594
Mailing Address - Country:US
Mailing Address - Phone:650-387-5468
Mailing Address - Fax:
Practice Address - Street 1:651 1ST ST W STE L
Practice Address - Street 2:
Practice Address - City:SONOMA
Practice Address - State:CA
Practice Address - Zip Code:95476-7046
Practice Address - Country:US
Practice Address - Phone:650-387-5468
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-12
Last Update Date:2017-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPENDINGOtherMEDICARE