=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437034295
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PREVENTIVE CARDIOLOGY AND INTEGRATIVE WEIGHT LOSS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/09/2025
-----------------------------------------------------
Last Update Date | 02/12/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2348 POST RD STE 104
-----------------------------------------------------
City | WARWICK
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02886-2271
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-244-8335
-----------------------------------------------------
Fax | 401-900-8003
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2348 POST RD STE 104
-----------------------------------------------------
City | WARWICK
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02886-2271
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-244-8335
-----------------------------------------------------
Fax | 401-900-8003
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF OPERATING OFFICER
-----------------------------------------------------
Name | AHMED TAHA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 401-244-8335
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QM2500X
-----------------------------------------------------
Taxonomy Name | Medical Specialty Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------