Healthcare Provider Details

I. General information

NPI: 1700511722
Provider Name (Legal Business Name): LIFE AND THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2022
Last Update Date: 07/22/2022
Certification Date: 07/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1503 S 22ND ST
EL CENTRO CA
92243-9403
US

IV. Provider business mailing address

1503 S 22ND ST
EL CENTRO CA
92243-9403
US

V. Phone/Fax

Practice location:
  • Phone: 310-351-9092
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: JOANNA BAEZ
Title or Position: OWNER
Credential:
Phone: 310-351-9092