MEDICARE: PHYSICIANS WEIGHT LOSS OF FLORIDA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant

General Provider Information

NPI Number	:	1053190611
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSICIANS WEIGHT LOSS OF FLORIDA

Provider Business Mailing Address
First Line	:	3515 DEL PRADO BLVD S
Second Line	:
City	:	SUITE 107
State	:	FL
Zip	:	33914
Country	:	US
Telephone Number	:	239-695-8446
Fax Number	:

Provider Business Practice Location Address
First Line	:	3515 DEL PRADO BLVD S STE 107
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33904-7289
Country	:	US
Telephone Number	:	239-695-8446
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN'S ASSISTANT
Name	:	NATALIE V ALANEZ
Credential	:	PA-C
Telephone Number	:	239-695-8446

Provider Enumeration Date	:	09/25/2023
Last Update Date	:	09/25/2023

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