DIVA WEIGHT LOSS LLC is a health service clinic center in Ridgeland, MS. DIVA WEIGHT LOSS LLC NPI is 1417230186. The provider is registered as an organization entity type.
The provider Is Doing Business As B/ba Performance Weight Loss And Medispa.
The provider's business location address is:
604 GOODRIDGE DR
SUITE A
RIDGELAND, MS
ZIP 39157-402
Phone: (769) 251-1040
The provider's authorized official is Caryn Alison Johnson .
The authorized official title is Owner and has the following contact phone number (601) 624-5840.
The CLIA number assigned to this NPI record is 25D2006834 - physician office with a certificate type of Certificate of Waiver.
The enumeration date for this NPI number is 9/20/2011 and was last updated on 2/13/2012.