Provider Demographics
NPI:1669217972
Name:ADVANCED WEIGHT LOSS AND WELLNESS
Entity type:Organization
Organization Name:ADVANCED WEIGHT LOSS AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAPHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RETTNER D.C.
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:925-962-9160
Mailing Address - Street 1:3244 CAMINO DIABLO
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-3212
Mailing Address - Country:US
Mailing Address - Phone:925-962-9160
Mailing Address - Fax:
Practice Address - Street 1:3244 CAMINO DIABLO
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-3212
Practice Address - Country:US
Practice Address - Phone:925-962-9160
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-27
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management