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General NPI Number Information
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NPI Number | 1720878549
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Entity Type | Organization
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Legal Business Name | CALIFORINA LIVING MEDICAL WEIGHT LOSS
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Dates
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Enumeration Date | 05/07/2025
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Last Update Date | 05/07/2025
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Provider Practice Location Address
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Address Line | 4080 LOMA VISTA RD
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City | VENTURA
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State | CA
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Zip | 93003-1811
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Country | US
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Telephone | 805-900-7396
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Fax | 805-900-7397
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Provider Business Mailing Address
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Address Line | 4080 LOMA VISTA RD
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City | VENTURA
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State | CA
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Zip | 93003-1811
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Country | US
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Telephone | 805-900-7396
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Fax | 805-900-7397
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Authorized Official
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Title or Position | DR/OWNER
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Name | DR. VINCENT COVALLIE
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Credential | MD
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Telephone | 914-774-9722
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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