Provider Demographics
NPI:1144504861
Name:MEDI-WEIGHT LOSS CLINIC OF BOCA RATON
Entity type:Organization
Organization Name:MEDI-WEIGHT LOSS CLINIC OF BOCA RATON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ARIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:OLIVEIRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-750-5270
Mailing Address - Street 1:555 N FEDERAL HWY
Mailing Address - Street 2:SUITE 18-20
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-3998
Mailing Address - Country:US
Mailing Address - Phone:561-750-5270
Mailing Address - Fax:561-750-5271
Practice Address - Street 1:555 N FEDERAL HWY
Practice Address - Street 2:SUITE 18-20
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-3998
Practice Address - Country:US
Practice Address - Phone:561-750-5270
Practice Address - Fax:561-750-5271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-29
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes132700000XDietary & Nutritional Service ProvidersDietary ManagerGroup - Single Specialty