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General NPI Number Information
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NPI Number | 1508306739
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Entity Type | Organization
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Legal Business Name | DR C'S WEIGHT LOSS AND ANTI-AGING MEDICINE, PC
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Dates
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Enumeration Date | 03/07/2017
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Last Update Date | 10/30/2017
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Provider Practice Location Address
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Address Line | 2737 W BASELINE RD SUITE 23
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City | TEMPE
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State | AZ
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Zip | 85283-1051
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Country | US
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Telephone | 480-245-6677
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Fax |
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Provider Business Mailing Address
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Address Line | 2737 W BASELINE RD SUITE 23
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City | TEMPE
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State | AZ
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Zip | 85283-1051
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Country | US
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Telephone | 480-245-6677
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Fax | 480-404-6547
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | ENRIQUE M CIFUENTES
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Credential | MD
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Telephone | 480-245-6677
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 42048
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License Number State | AZ
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