Healthcare Provider Details

I. General information

NPI: 1154926947
Provider Name (Legal Business Name): INFINITY LIFE WELLNESS CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2020
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13701 SW 88TH ST STE 302
MIAMI FL
33186-1309
US

IV. Provider business mailing address

13701 SW 88TH ST STE 302
MIAMI FL
33186-1309
US

V. Phone/Fax

Practice location:
  • Phone: 786-842-1489
  • Fax: 786-842-1490
Mailing address:
  • Phone: 786-842-1489
  • Fax: 786-842-1490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ERICK ESPINOZA
Title or Position: OFFICER
Credential:
Phone: 786-842-1489