Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Premier Weight Loss Medical Clinic

Organization Dietary Manager · NPI 1407115710

Premier Weight Loss Medical Clinic is a Dietary Manager in San Pedro, California. Registered with an NPI since 2012.

In the registry since
2012

Practice location Address checks out

719 S Averill Ave
San Pedro, CA 90732-3813
Phone: (310) 832-9080
Fax: (310) 832-9027
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dietary Manager (primary) Taxonomy 132700000X

Record details

NPI number1407115710
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Kristina Kutsina — Manager · (310) 832-9080
NPI enumeratedMay 7, 2012
Last updated in NPPESMay 7, 2012
Mailing address719 S Averill Ave, San Pedro, CA 90732-3813