MEDICARE: WEIGHT LOSS INSTITUTE OF ARIZONA 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
1	208600000X	Surgery Physician

General Provider Information

NPI Number	:	1477591402
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEIGHT LOSS INSTITUTE OF ARIZONA LLC

Provider Business Mailing Address
First Line	:	1492 S MILL AVE
Second Line	:	SUITE 201
City	:	TEMPE
State	:	AZ
Zip	:	85281-5652
Country	:	US
Telephone Number	:	480-829-6100
Fax Number	:	480-446-9475

Provider Business Practice Location Address
First Line	:	1492 S MILL AVE
Second Line	:	SUITE 201
City	:	TEMPE
State	:	AZ
Zip	:	85281-5652
Country	:	US
Telephone Number	:	480-829-6100
Fax Number	:	480-446-9475

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	LAURA WOOD
Credential	:
Telephone Number	:	480-829-6100

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	08/22/2020

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