Healthcare Provider Details

I. General information

NPI: 1811683022
Provider Name (Legal Business Name): WESTERN COLORADO WEIGHT CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2023
Last Update Date: 08/09/2023
Certification Date: 08/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

551 GRAND AVE # S302
GRAND JUNCTION CO
81501-2694
US

IV. Provider business mailing address

2820 VESTRELLA DR
MODESTO CA
95356-9377
US

V. Phone/Fax

Practice location:
  • Phone: 970-773-5777
  • Fax:
Mailing address:
  • Phone: 209-505-9399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LORI ANN WENZ
Title or Position: NP/OWNER
Credential: NP
Phone: 970-773-5777