Healthcare Provider Details

I. General information

NPI: 1003762170
Provider Name (Legal Business Name): LIFE BEAUTY & HEALTH SPA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4684 NW 183RD ST
MIAMI GARDENS FL
33055-3054
US

IV. Provider business mailing address

4684 NW 183RD ST
MIAMI GARDENS FL
33055-3054
US

V. Phone/Fax

Practice location:
  • Phone: 305-399-7806
  • Fax: 305-399-7807
Mailing address:
  • Phone: 305-399-7806
  • Fax: 305-399-7807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PEDRO ALEJANDRO MARTINEZ
Title or Position: PRESIDENT
Credential: OWNER
Phone: 305-399-7806