Healthcare Provider Details

I. General information

NPI: 1043058738
Provider Name (Legal Business Name): FLYTE MEDICAL OF CALIFORNIA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2024
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69 GROVE ST
NEW CANAAN CT
06840-5325
US

IV. Provider business mailing address

1204 MAIN ST STE 576
BRANFORD CT
06405-3787
US

V. Phone/Fax

Practice location:
  • Phone: 844-359-8363
  • Fax:
Mailing address:
  • Phone: 844-359-8363
  • Fax: 833-929-3520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID BASS
Title or Position: COO
Credential:
Phone: 415-710-7775