Organization
WEIGHT AWAY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSICA THACS M.A. (OFFICE MANAGER)
(559) 297-7565
Entity
Organization
Contact information
Practice address
1895 HERNDON AVE, SUITE 105, CLOVIS, CA 93611
(559) 297-7563
Mailing address
255 W BULLARD, SUITE 109, CLOVIS, CA 93612
(559) 297-7563
(559) 297-5374
Taxonomy
Speciality
Code
Description
License number
State
133NN1002X
Nutrition Education Nutritionist
Primary
00A786030
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11201094
CAQH
—
Enumeration date
08/02/2010
Last updated
08/02/2010
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