# ISLAND WEIGHT LOSS

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** ISLAND WEIGHT LOSS
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1023581576
- **Legal business name:** ISLAND WEIGHT LOSS
- **Authorized official:** MS. PATRICIA JANE LAURIA (PRESIDENT)
- **Authorized official phone:** (321) 453-2410

## Contact information

- **Practice address:** 1365 N COURTENAY PKWY, MERRITT ISLAND, FL 32953-4405
- **Practice address phone:** (321) 453-2410
- **Mailing address:** 1365 N COURTENAY PKWY, MERRITT ISLAND, FL 32953-4405
- **Mailing address phone:** (321) 453-2410

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QB0002X | Obesity Medicine (Family Medicine) Physician | — | NULL | Yes |
| 207QB0002X | Obesity Medicine (Family Medicine) Physician | — | — | Yes |

## Other

- **Enumeration date:** 01/08/2019
- **Last updated:** 01/08/2019