Provider Demographics
NPI:1659031631
Name:PIVOT WEIGHT LOSS CENTER LLC
Entity type:Organization
Organization Name:PIVOT WEIGHT LOSS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:DEBARROS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-485-8585
Mailing Address - Street 1:6838 E CHENEY DR
Mailing Address - Street 2:
Mailing Address - City:PARADISE VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85253-3525
Mailing Address - Country:US
Mailing Address - Phone:480-485-8585
Mailing Address - Fax:
Practice Address - Street 1:4860 E BASELINE RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4669
Practice Address - Country:US
Practice Address - Phone:480-292-5145
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-18
Last Update Date:2021-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty