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General NPI Number Information
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NPI Number | 1477359016
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Entity Type | Organization
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Legal Business Name | AGAFAY WEIGHT LOSS CENTER LLC
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Dates
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Enumeration Date | 02/24/2025
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Last Update Date | 04/22/2025
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Provider Practice Location Address
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Address Line | 10420 OLD OLIVE STREET RD STE 100
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City | SAINT LOUIS
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State | MO
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Zip | 63141-5937
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Country | US
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Telephone | 314-914-4833
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Fax |
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Provider Business Mailing Address
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Address Line | 10420 OLD OLIVE STREET RD STE 100
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City | SAINT LOUIS
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State | MO
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Zip | 63141-5937
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Country | US
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Telephone | 314-914-4833
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Fax |
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Authorized Official
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Title or Position | MD/OWNER
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Name | PENINNAH MUTUNGI
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Credential | MD
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Telephone | 401-787-8864
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083B0002X
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Taxonomy Name | Obesity Medicine (Preventive Medicine) Physician
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License Number |
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License Number State |
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