MEDICARE: HEALTHFLY INCORPORATED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251K00000X	Public Health or Welfare Agency	A88766	CA

General Provider Information

NPI Number	:	1245464759
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHFLY INCORPORATED

Provider Business Mailing Address
First Line	:	1601 N SEPULVEDA BLVD # 144
Second Line	:
City	:	MANHATTAN BEACH
State	:	CA
Zip	:	90266-5111
Country	:	US
Telephone Number	:	800-530-9850
Fax Number	:	866-736-6258

Provider Business Practice Location Address
First Line	:	1601 N SEPULVEDA BLVD # 144
Second Line	:
City	:	MANHATTAN BEACH
State	:	CA
Zip	:	90266-5111
Country	:	US
Telephone Number	:	800-530-9850
Fax Number	:	866-736-6258

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DEONZA THYMES
Credential	:	M.D.
Telephone Number	:	323-972-2445

Provider Enumeration Date	:	05/12/2009
Last Update Date	:	05/12/2009

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Directions to “HEALTHFLY INCORPORATED ” Practice Location

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