Glendale Weightloss LLC

Primary specialty

Obesity Medicine (Family Medicine) PhysicianTaxonomy code 207QB0002X

License

500010862 Issued in AZ

Legal business name

GLENDALE WEIGHTLOSS LLC

Practice address

5310 W Thunderbird Rd
Ste 308
Glendale, AZ 85306-4706

Phone

(623) 825-7931

Fax

(623) 240-2673

NPI assigned

Jun 23, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Edward Kaloust

Title

Manager Member

Phone

(813) 228-6334

Specialties & licenses 1

Addresses

Other names 1

• Medi-Weightloss Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1435017600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1435017600000",
    "number": "1376925602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "509 S HYDE PARK AVE",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336062266",
            "telephone_number": "813-228-6334",
            "fax_number": "813-228-6763"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5310 W THUNDERBIRD RD",
            "address_2": "STE 308",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853064706",
            "telephone_number": "623-825-7931",
            "fax_number": "623-240-2673"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLENDALE WEIGHTLOSS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-23",
        "last_updated": "2015-06-23",
        "status": "A",
        "authorized_official_last_name": "KALOUST",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_title_or_position": "MANAGER MEMBER",
        "authorized_official_telephone_number": "813-228-6334"
    },
    "taxonomies": [
        {
            "code": "207QB0002X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine, Obesity Medicine",
            "state": "AZ",
            "license": "500010862",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medi-Weightloss",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Obesity Medicine (Family Medicine) Physician in Glendale, AZ
• Providers in Glendale, AZ by specialty
• Obesity Medicine (Family Medicine) Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.