Healthcare Provider Details

I. General information

NPI: 1962310920
Provider Name (Legal Business Name): GOOD LIFE COMMUNITY CENTER CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7855 NW 12TH ST STE 221
DORAL FL
33126-1819
US

IV. Provider business mailing address

7855 NW 12TH ST STE 221
DORAL FL
33126-1819
US

V. Phone/Fax

Practice location:
  • Phone: 786-558-5062
  • Fax: 786-359-4008
Mailing address:
  • Phone: 786-558-5062
  • Fax: 786-359-4008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: YANAILYS RODRIGUEZ
Title or Position: OWNER
Credential:
Phone: 786-558-5062