Healthcare Provider Details

I. General information

NPI: 1457520025
Provider Name (Legal Business Name): LIFESPAN HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2008
Last Update Date: 10/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2295 NW CORPORATE BLVD 231
BOCA RATON FL
33431-7373
US

IV. Provider business mailing address

2295 NW CORPORATE BLVD 231
BOCA RATON FL
33431-7373
US

V. Phone/Fax

Practice location:
  • Phone: 561-995-9762
  • Fax: 561-995-9799
Mailing address:
  • Phone: 561-995-9762
  • Fax: 561-995-9799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License NumberPY5283
License Number StateFL

VIII. Authorized Official

Name: DR. DANIEL LOBOVITS
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 561-995-9762