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NPI Code Detail

MEDICARE: DIABETES & WEIGHT LOSS CENTER LLC

MEDICARE: DIABETES & WEIGHT LOSS CENTER LLC
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
1363LF0000XFamily Nurse Practitioner

General Provider Information

NPI Number : 1114654902
Entity Type Code : Organization
Provider Name (Legal Business Name) : DIABETES & WEIGHT LOSS CENTER LLC
Provider Business Mailing Address
First Line : 1410 W BROADWAY ST STE 203
Second Line :
City : OVIEDO
State : FL
Zip : 32765-6472
Country : US
Telephone Number : 407-890-1876
Fax Number : 888-498-4294
Provider Business Practice Location Address
First Line : 1410 W BROADWAY ST STE 203
Second Line :
City : OVIEDO
State : FL
Zip : 32765-6472
Country : US
Telephone Number : 407-865-2716
Fax Number :
Authorized Official
Title or Position : MGR
Name : ADRIEL PEREZ
Credential : APRN
Telephone Number : 407-890-1876
Provider Enumeration Date : 08/02/2022
Last Update Date : 11/09/2022

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Directions to “DIABETES & WEIGHT LOSS CENTER LLC ” Practice Location

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