Healthcare Provider Details

I. General information

NPI: 1043845548
Provider Name (Legal Business Name): NEIGHBORHOOD HEALTH AND WEIGHT MEDICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2020
Last Update Date: 03/05/2020
Certification Date: 03/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27014 CENTER RIDGE RD
WESTLAKE OH
44145-4045
US

IV. Provider business mailing address

PO BOX 770577
LAKEWOOD OH
44107-0029
US

V. Phone/Fax

Practice location:
  • Phone: 810-513-8063
  • Fax:
Mailing address:
  • Phone: 810-513-8063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARIA LOURDES TRONCALES MALICDEM
Title or Position: OWNER
Credential: MD
Phone: 810-513-8063