Healthcare Provider Details

I. General information

NPI: 1396152815
Provider Name (Legal Business Name): LIFE FORCE HEALTH ORGANIZATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2014
Last Update Date: 07/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BO PASARELL NUM 21
COMERIO PR
00782
US

IV. Provider business mailing address

PO BOX 356
VEGA ALTA PR
00692-0356
US

V. Phone/Fax

Practice location:
  • Phone: 787-695-5556
  • Fax: 787-875-4904
Mailing address:
  • Phone: 787-695-5556
  • Fax: 787-875-4904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number309783
License Number StatePR

VIII. Authorized Official

Name: DR. LUIS M GONZALEZ BERMUDEZ
Title or Position: PRESIDENTE
Credential: MD
Phone: 787-316-1212