Premier Weight Loss Medical Clinic

Primary specialty

Dietary ManagerTaxonomy code 132700000X

Legal business name

PREMIER WEIGHT LOSS MEDICAL CLINIC

Practice address

719 S Averill Ave
San Pedro, CA 90732-3813

Phone

(310) 832-9080

Fax

(310) 832-9027

NPI assigned

May 7, 2012

Last updated

May 7, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kristina Kutsina

Title

Manager

Phone

(310) 832-9080

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1336348800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1336348800000",
    "number": "1407115710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "719 S AVERILL AVE",
            "city": "SAN PEDRO",
            "state": "CA",
            "postal_code": "907323813",
            "telephone_number": "310-832-9080",
            "fax_number": "310-832-9027"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "719 S AVERILL AVE",
            "city": "SAN PEDRO",
            "state": "CA",
            "postal_code": "907323813",
            "telephone_number": "310-832-9080",
            "fax_number": "310-832-9027"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER WEIGHT LOSS MEDICAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-07",
        "last_updated": "2012-05-07",
        "status": "A",
        "authorized_official_last_name": "KUTSINA",
        "authorized_official_first_name": "KRISTINA",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "310-832-9080"
    },
    "taxonomies": [
        {
            "code": "132700000X",
            "taxonomy_group": "",
            "desc": "Dietary Manager",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dietary Manager in San Pedro, CA
• Providers in San Pedro, CA by specialty
• Dietary Manager in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2012; 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.