Healthcare Provider Details

I. General information

NPI: 1104408624
Provider Name (Legal Business Name): S & L HEALTHY CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2021
Last Update Date: 10/11/2021
Certification Date: 10/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14255 SW 42ND ST STE 13B
MIAMI FL
33175-6408
US

IV. Provider business mailing address

14255 SW 42ND ST STE 13B
MIAMI FL
33175-6408
US

V. Phone/Fax

Practice location:
  • Phone: 305-219-8606
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LIZET LOPEZ
Title or Position: PRESIDENT
Credential: APRN
Phone: 305-219-8606