Healthcare Provider Details

I. General information

NPI: 1982743563
Provider Name (Legal Business Name): HOPE OF LIFE MEDICAL CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 04/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 79TH STREET CSWY SUITE 1406
NORTH BAY VILLAGE FL
33141-4188
US

IV. Provider business mailing address

1440 79TH STREET CSWY SUITE 1406
NORTH BAY VILLAGE FL
33141-4188
US

V. Phone/Fax

Practice location:
  • Phone: 305-877-9483
  • Fax:
Mailing address:
  • Phone: 305-877-9483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MARIA G. ROQUE
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 786-431-5102