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General NPI Number Information
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NPI Number | 1811683022
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Entity Type | Organization
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Legal Business Name | WESTERN COLORADO WEIGHT CARE, LLC
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Dates
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Enumeration Date | 04/12/2023
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Last Update Date | 08/09/2023
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Provider Practice Location Address
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Address Line | 551 GRAND AVE # S302
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City | GRAND JUNCTION
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State | CO
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Zip | 81501-2694
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Country | US
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Telephone | 970-773-5777
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Fax |
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Provider Business Mailing Address
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Address Line | 2820 VESTRELLA DR
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City | MODESTO
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State | CA
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Zip | 95356-9377
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Country | US
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Telephone | 209-505-9399
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Fax |
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Authorized Official
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Title or Position | NP/OWNER
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Name | LORI ANN WENZ
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Credential | NP
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Telephone | 970-773-5777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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