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General NPI Number Information
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NPI Number | 1063852069
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Entity Type | Organization
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Legal Business Name | DOCTORS WEIGHT LOSS CENTER & WELLNESS
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Dates
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Enumeration Date | 07/05/2013
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Last Update Date | 07/05/2013
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Provider Practice Location Address
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Address Line | 11215 S INTERSTATE 35 SUITE 114
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City | AUSTIN
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State | TX
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Zip | 78747-1863
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Country | US
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Telephone | 512-782-2084
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Fax | 512-782-2088
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Provider Business Mailing Address
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Address Line | 11215 S INTERSTATE 35 SUITE 114
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City | AUSTIN
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State | TX
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Zip | 78747-1863
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Country | US
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Telephone | 512-782-2084
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Fax | 512-782-2088
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Authorized Official
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Title or Position | MANAGING PARNER
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Name | MRS. ADYS MIRABAL
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Credential | VICE PRESIDENT
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Telephone | 512-782-2084
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SA2200X
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Taxonomy Name | Adult Health Clinical Nurse Specialist
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License Number | 736533
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License Number State | TX
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