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General NPI Number Information
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NPI Number | 1477920189
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Entity Type | Organization
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Legal Business Name | COMPREHENSIVE MEDICAL WEIGHT LOSS
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Dates
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Enumeration Date | 08/28/2015
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Last Update Date | 08/28/2015
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Provider Practice Location Address
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Address Line | 4810 RUSINA RD
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City | COLORADO SPRINGS
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State | CO
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Zip | 80907-8104
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Country | US
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Telephone | 719-635-0144
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Fax | 866-530-9664
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Provider Business Mailing Address
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Address Line | 4810 RUSINA RD
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City | COLORADO SPRINGS
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State | CO
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Zip | 80907-8104
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Country | US
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Telephone | 719-635-0144
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Fax | 866-530-9664
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | MS. MARY VERITY
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Credential |
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Telephone | 719-635-0144
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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