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General NPI Number Information
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NPI Number | 1043012842
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Entity Type | Organization
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Legal Business Name | HEALTHY LIFE MEDICAL PRACTICE. LLC
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Dates
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Enumeration Date | 03/25/2025
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Last Update Date | 03/25/2025
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Provider Practice Location Address
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Address Line | 5925 IMPERIAL PKWY STE 117
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City | MULBERRY
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State | FL
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Zip | 33860-8692
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Country | US
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Telephone | 863-304-5151
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Fax |
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Provider Business Mailing Address
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Address Line | 5925 IMPERIAL PKWY STE 117
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City | MULBERRY
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State | FL
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Zip | 33860-8692
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Country | US
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Telephone | 863-304-5151
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Fax |
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Authorized Official
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Title or Position | MD DIRECTOR/ OWNER
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Name | DR. LUZ PATRICIA MORALES GONZALEZ
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Credential | MD
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Telephone | 631-946-4546
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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