Healthcare Provider Details

I. General information

NPI: 1043633803
Provider Name (Legal Business Name): MD WEIGHT MANAGEMENT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2014
Last Update Date: 07/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2340 CLAY ST FL 6
SAN FRANCISCO CA
94115-1932
US

IV. Provider business mailing address

2340 CLAY ST FL 6
SAN FRANCISCO CA
94115-1932
US

V. Phone/Fax

Practice location:
  • Phone: 415-674-5200
  • Fax: 415-600-3705
Mailing address:
  • Phone: 415-674-5200
  • Fax: 415-600-3705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code132700000X
TaxonomyDietary Manager
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ANITA DEMAS
Title or Position: MANAGING PARTNER
Credential: M.D.
Phone: 415-674-5200