Provider Demographics
NPI:1871875492
Name:SUCCESS IN LIFE WEIGHT MANAGEMENT
Entity type:Organization
Organization Name:SUCCESS IN LIFE WEIGHT MANAGEMENT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-323-5483
Mailing Address - Street 1:713 OAK GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-4319
Mailing Address - Country:US
Mailing Address - Phone:650-323-5483
Mailing Address - Fax:
Practice Address - Street 1:713 OAK GROVE AVE
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-4319
Practice Address - Country:US
Practice Address - Phone:650-323-5483
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-10
Last Update Date:2011-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization