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Organization
FAMILY MEDICINE & WEIGHT MANAGEMENT SPECIALTY, P.L.L.C.
Active
Organization
FAMILY MEDICINE & WEIGHT MANAGEMENT SPECIALTY, P.L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIRSTEN A SORENSEN (ADMINISTRATOR)
(602) 431-1152
Entity
Organization
Contact information
Practice address
2222 S AVENUE A, YUMA, AZ 85364-8315
(928) 276-4381
Mailing address
2189 S. AVENUE A, SUITE A, YUMA, AZ 85364-8880
(928) 276-4381
(928) 276-9086
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4158
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
Z178594
MEDICARE PTAN FOR STATEOF ARIZONA
AZ
Enumeration date
10/01/2009
Last updated
07/21/2022
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