Healthcare Provider Details

I. General information

NPI: 1043012842
Provider Name (Legal Business Name): HEALTHY LIFE MEDICAL PRACTICE. LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2025
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5925 IMPERIAL PKWY STE 117
MULBERRY FL
33860-8692
US

IV. Provider business mailing address

5925 IMPERIAL PKWY STE 117
MULBERRY FL
33860-8692
US

V. Phone/Fax

Practice location:
  • Phone: 863-304-5151
  • Fax:
Mailing address:
  • Phone: 863-304-5151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. LUZ PATRICIA MORALES GONZALEZ
Title or Position: MD DIRECTOR/ OWNER
Credential: MD
Phone: 631-946-4546