Healthcare Provider Details

I. General information

NPI: 1952127912
Provider Name (Legal Business Name): LYFEMD INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2024
Last Update Date: 11/25/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 GROVE STREET
LOS GATOS CA
95030
US

IV. Provider business mailing address

67 GROVE STREET
LOS GATOS CA
95030
US

V. Phone/Fax

Practice location:
  • Phone: 888-897-1557
  • Fax:
Mailing address:
  • Phone: 250-427-9876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER FROST
Title or Position: HUMAN RESOURCES/ACCOUNTING MANAGER
Credential:
Phone: 250-427-9876