Provider Demographics
NPI:1194172510
Name:360 MEDICAL WEIGHT SPECIALISTS
Entity type:Organization
Organization Name:360 MEDICAL WEIGHT SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:GARTNER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:925-944-5678
Mailing Address - Street 1:2255 YGNACIO VALLEY RD
Mailing Address - Street 2:SUITE G
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-3343
Mailing Address - Country:US
Mailing Address - Phone:925-944-5678
Mailing Address - Fax:
Practice Address - Street 1:2255 YGNACIO VALLEY RD
Practice Address - Street 2:SUITE G
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3343
Practice Address - Country:US
Practice Address - Phone:925-944-5678
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-16
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RB0002XAllopathic & Osteopathic PhysiciansInternal MedicineObesity MedicineGroup - Single Specialty