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General NPI Number Information
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NPI Number | 1003254533
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Entity Type | Organization
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Legal Business Name | OLDE NAPLES NUVIVA MEDICAL WEIGHT LOSS INC
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Dates
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Enumeration Date | 06/06/2013
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Last Update Date | 06/06/2013
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Provider Practice Location Address
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Address Line | 201 8TH ST S 103
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City | NAPLES
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State | FL
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Zip | 34102-6107
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Country | US
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Telephone | 239-384-9115
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Fax |
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Provider Business Mailing Address
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Address Line | 201 8TH ST S 103
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City | NAPLES
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State | FL
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Zip | 34102-6107
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ALEX JOSEPH
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Credential |
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Telephone | 239-466-4007
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QB0002X
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Taxonomy Name | Obesity Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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