Provider Demographics
NPI:1700310596
Name:WEIGHT LIFE MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:WEIGHT LIFE MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GILBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:ESPINOSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-332-2504
Mailing Address - Street 1:8370 W FLAGLER ST
Mailing Address - Street 2:SUITE 240
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-2094
Mailing Address - Country:US
Mailing Address - Phone:786-332-2504
Mailing Address - Fax:786-332-2586
Practice Address - Street 1:8370 W FLAGLER ST
Practice Address - Street 2:SUITE 240
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2094
Practice Address - Country:US
Practice Address - Phone:786-332-2504
Practice Address - Fax:786-332-2586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-18
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC12511261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation