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General NPI Number Information
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NPI Number | 1164931754
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Entity Type | Organization
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Legal Business Name | TAKE BACK YOUR LIFE WEIGHT LOSS SOLUTIONS, LLC
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Dates
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Enumeration Date | 09/26/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 6005 S 36TH ST
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City | PHOENIX
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State | AZ
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Zip | 85042-4901
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Country | US
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Telephone | 602-595-5145
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Fax | 602-595-5302
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Provider Business Mailing Address
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Address Line | 6005 S 36TH ST
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City | PHOENIX
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State | AZ
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Zip | 85042-4901
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Country | US
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Telephone | 602-595-5145
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Fax | 602-595-5302
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | IRYNA SANCHEZ
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Credential |
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Telephone | 602-595-5145
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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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