MEDICARE: FIRST CHOICE WEIGHT LOSS INC.

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	208600000X	Surgery Physician

General Provider Information

NPI Number	:	1265776660
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRST CHOICE WEIGHT LOSS INC.

Provider Business Mailing Address
First Line	:	5757 WESTHEIMER RD STE 100B
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77057-5721
Country	:	US
Telephone Number	:	281-232-0297
Fax Number	:

Provider Business Practice Location Address
First Line	:	5757 WESTHEIMER RD STE 100B
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77057-5721
Country	:	US
Telephone Number	:	281-232-0297
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MOHAMED MAZEN SEIJARI
Credential	:	LSA
Telephone Number	:	832-344-6916

Provider Enumeration Date	:	11/26/2012
Last Update Date	:	11/26/2012

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