Healthcare Provider Details

I. General information

NPI: 1730118472
Provider Name (Legal Business Name): HEALTHY LIFE INTL,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

541 W COLORADO ST SUITE 206
GLENDALE CA
91204-3638
US

IV. Provider business mailing address

541 W COLORADO ST SUITE 206
GLENDALE CA
91204-3638
US

V. Phone/Fax

Practice location:
  • Phone: 818-637-2079
  • Fax:
Mailing address:
  • Phone: 818-637-2079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License NumberTG501
License Number StateCA

VIII. Authorized Official

Name: HARUT GHAMBARYAN
Title or Position: PRESIDENT
Credential:
Phone: 818-637-2079