Organization
PREMIER WEIGHT LOSS MEDICAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTINA KUTSINA (MANAGER)
(310) 832-9080
Entity
Organization
Contact information
Practice address
719 S AVERILL AVE, SAN PEDRO, CA 90732-3813
(310) 832-9080
(310) 832-9027
Mailing address
719 S AVERILL AVE, SAN PEDRO, CA 90732-3813
(310) 832-9080
(310) 832-9027
Taxonomy
Speciality
Code
Description
License number
State
132700000X
Dietary Manager
Primary
—
—
Other
Enumeration date
05/07/2012
Last updated
05/07/2012
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