Organization
FLORIDA WEIGHT LOSS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE M FRESTA RD (REGISTERED DIETITIAN)
(941) 705-2210
Entity
Organization
Contact information
Practice address
1590 79TH AVE N, SAINT PETERSBURG, FL 33702-4039
(941) 705-2210
Mailing address
1590 79TH AVE N, SAINT PETERSBURG, FL 33702-4039
(941) 705-2210
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1487264339
—
FL
Enumeration date
08/12/2020
Last updated
08/12/2020
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