Le Reve Anti-Aging and Weight Loss Center

Primary specialty

Health Service Clinic/CenterTaxonomy code 261QH0100X

Legal business name

LE REVE ANTI-AGING AND WEIGHT LOSS CENTER

Practice address

7000 Bryant Irvin Rd
Ste 108
Fort Worth, TX 76132-4250

Phone

(682) 703-1400

Fax

(817) 887-5779

NPI assigned

Apr 11, 2016

Organization subpart

No

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

Authorized official

Name

Jason Tinley, MD

Title

Principal

Phone

(682) 703-1400

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1460332800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1460332800000",
    "number": "1770947160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7000 BRYANT IRVIN RD",
            "address_2": "STE 108",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761324250",
            "telephone_number": "682-703-1400",
            "fax_number": "817-887-5779"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7000 BRYANT IRVIN RD",
            "address_2": "STE 108",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761324250",
            "telephone_number": "682-703-1400",
            "fax_number": "817-887-5779"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LE REVE ANTI-AGING AND WEIGHT LOSS CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-11",
        "last_updated": "2016-04-11",
        "status": "A",
        "authorized_official_last_name": "TINLEY",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "PRINCIPAL",
        "authorized_official_telephone_number": "682-703-1400",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QC1800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Corporate Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carol Elizabeth Lazell, D.D.S.
• LCB Medical Supplies, LLC
• LCD Practice, PLLC
• LCS Counseling and Consulting Agency
• Rachel Le Fevers, AGACNP-BC
• Le-Nutrition LLC
• An Le
• Andy Le
• Andy Le, DDS
• Anh Le

• Health Service Clinic/Center in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Health Service Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2016; 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.