Healthcare Provider Details

I. General information

NPI: 1376989830
Provider Name (Legal Business Name): CLEARWATER WEIGHTLOSS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2013
Last Update Date: 06/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2454 N MCMULLEN BOOTH RD SUITE 601
CLEARWATER FL
33759-1353
US

IV. Provider business mailing address

2454 N MCMULLEN BOOTH RD SUITE 601
CLEARWATER FL
33759-1353
US

V. Phone/Fax

Practice location:
  • Phone: 727-726-6338
  • Fax: 727-796-8764
Mailing address:
  • Phone: 727-726-6338
  • Fax: 727-796-8764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VB0002X
TaxonomyObesity Medicine (Obstetrics & Gynecology) Physician
License NumberME 48354
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207VB0002X
TaxonomyObesity Medicine (Obstetrics & Gynecology) Physician
License NumberME 71673
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License NumberME 48354
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License NumberME 71673
License Number StateFL

VIII. Authorized Official

Name: EDWARD ZBELLA
Title or Position: PRESIDENT
Credential: MD
Phone: 727-726-6338