Healthcare Provider Details

I. General information

NPI: 1093501959
Provider Name (Legal Business Name): WEST EXPRESS WEIGHT LOSS COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2025
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4620 BRADFORD RD
CLEVELAND OH
44121-3851
US

IV. Provider business mailing address

4620 BRADFORD RD
CLEVELAND OH
44121-3851
US

V. Phone/Fax

Practice location:
  • Phone: 216-316-7366
  • Fax:
Mailing address:
  • Phone: 216-316-7366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: CHARLETHEA WEST
Title or Position: NURSE PRACTITIONER
Credential: NP
Phone: 216-374-9519