Healthcare Provider Details

I. General information

NPI: 1790600468
Provider Name (Legal Business Name): LIFE CARE FAMILY MEDICAL GROUP CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4118 W 12TH AVE
HIALEAH FL
33012-4107
US

IV. Provider business mailing address

4118 W 12TH AVE
HIALEAH FL
33012-4107
US

V. Phone/Fax

Practice location:
  • Phone: 786-810-0385
  • Fax:
Mailing address:
  • Phone: 786-810-0385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRYAN NAPOLES PEREZ
Title or Position: PRESIDENT
Credential:
Phone: 786-854-3170