Healthcare Provider Details

I. General information

NPI: 1316970296
Provider Name (Legal Business Name): LIFESTREAM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3350 SW 148TH AVE STE 202-B
MIRAMAR FL
33027-3257
US

IV. Provider business mailing address

2471 NW 72ND AVE
MIAMI FL
33122-1829
US

V. Phone/Fax

Practice location:
  • Phone: 305-264-2021
  • Fax: 305-265-0755
Mailing address:
  • Phone: 305-264-2021
  • Fax: 305-265-0755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number
License Number State

VIII. Authorized Official

Name: DOVI FAIVISH
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 305-264-2021