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General NPI Number Information
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NPI Number | 1942979422
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Entity Type | Organization
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Legal Business Name | RED MOUNTAIN WEIGHT LOSS GILBERT, LLC
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Dates
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Enumeration Date | 09/08/2021
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Last Update Date | 09/08/2021
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Provider Practice Location Address
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Address Line | 2765 S MARKET ST STE 103
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City | GILBERT
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State | AZ
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Zip | 85295-1305
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Country | US
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Telephone | 480-347-3413
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Fax |
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Provider Business Mailing Address
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Address Line | 14000 N HAYDEN RD STE 180
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City | SCOTTSDALE
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State | AZ
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Zip | 85260-5561
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Country | US
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Telephone | 480-347-3413
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Fax |
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Authorized Official
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Title or Position | OWNER & CHIEF MEDICAL OFFICER
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Name | DR. SUZANNE BENTZ
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Credential | DO
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Telephone | 480-347-3413
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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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