MEDICARE: CENTER FOR HEALTH & LONGEVITY, LLC

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	261QH0100X	Health Service Clinic/Center	ME102199	FL

General Provider Information

NPI Number	:	1568701761
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER FOR HEALTH & LONGEVITY, LLC

Provider Business Mailing Address
First Line	:	2499 GLADES RD
Second Line	:	SUITE 305A
City	:	BOCA RATON
State	:	FL
Zip	:	33431-7209
Country	:	US
Telephone Number	:	561-416-4391
Fax Number	:	954-337-2996

Provider Business Practice Location Address
First Line	:	1244 S FEDERAL HWY
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33316-2074
Country	:	US
Telephone Number	:	954-713-6118
Fax Number	:	954-337-2996

Authorized Official
Title or Position	:	CEO
Name	:	MR. JOHN DELUCA
Credential	:	M.D.
Telephone Number	:	954-583-3335

Provider Enumeration Date	:	02/07/2013
Last Update Date	:	02/07/2013

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