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General NPI Number Information
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NPI Number | 1790194710
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Entity Type | Organization
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Legal Business Name | COMPREHENSIVE MEDICAL WEIGHT LOSS,LLC
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Dates
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Enumeration Date | 08/04/2014
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Last Update Date | 08/04/2014
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Provider Practice Location Address
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Address Line | 110 S PARKSIDE DR
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City | COLORADO SPRINGS
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State | CO
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Zip | 80910-3129
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Country | US
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Telephone | 719-635-0144
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Fax |
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Provider Business Mailing Address
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Address Line | 110 S PARKSIDE DR
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City | COLORADO SPRINGS
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State | CO
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Zip | 80910-3129
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Country | US
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Telephone | 719-635-0144
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Fax |
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Authorized Official
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Title or Position | CO-OWNER/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 | 132700000X
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Taxonomy Name | Dietary Manager
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License Number |
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License Number State |
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