NPI 1407115710

Premier Weight Loss Medical Clinic

Organisation Dietary Manager San Pedro, CA

Practice location

Address: 719 S Averill Ave, San Pedro, CA 90732-3813
Phone: (310) 832-9080
Fax: (310) 832-9027

Authorised official

Name: Kristina Kutsina
Title: Manager
Phone: (310) 832-9080

Registered specialties

Dietary Manager Primary

Dietary & Nutritional Service Providers Taxonomy 132700000X

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Registry record

NPI: 1407115710
Entity type: Organization
NPI issued: 7 May 2012
Record last updated: 7 May 2012

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.