MEDICARE: SIX DAY WEIGHT LOSS MEDICAL CORPORATION

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	261QM2500X	Medical Specialty Clinic/Center

General Provider Information

NPI Number	:	1881407542
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIX DAY WEIGHT LOSS MEDICAL CORPORATION

Provider Business Mailing Address
First Line	:	14900 VENTURA BLVD STE 100
Second Line	:
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91403-3484
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	14900 VENTURA BLVD STE 100
Second Line	:
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91403-3484
Country	:	US
Telephone Number	:	818-782-9038
Fax Number	:

Authorized Official
Title or Position	:	FCOO
Name	:	MICHAEL MURPHY
Credential	:
Telephone Number	:	813-426-2788

Provider Enumeration Date	:	01/28/2025
Last Update Date	:	01/28/2025

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