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General NPI Number Information
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NPI Number | 1659759637
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Entity Type | Organization
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Legal Business Name | ADVANCED WEIGHT LOSS AND WELLNESS
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Dates
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Enumeration Date | 05/11/2015
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Last Update Date | 05/11/2015
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Provider Practice Location Address
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Address Line | 959 MOUNTAIN VIEW DR
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City | LAFAYETTE
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State | CA
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Zip | 94549-3729
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Country | US
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Telephone | 925-962-9160
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Fax |
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Provider Business Mailing Address
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Address Line | 959 MOUNTAIN VIEW DR
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City | LAFAYETTE
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State | CA
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Zip | 94549-3729
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Country | US
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Telephone | 925-962-9160
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Fax |
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Authorized Official
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Title or Position | OWNER/ DOCTOR OF CHIROPRACTIC
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Name | DR. RAPHAEL I. RETTNER
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Credential | D.C.
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Telephone | 925-962-9160
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 14477
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License Number State | CA
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