=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215041066
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MORE LIFE MEDICAL CENTER INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/18/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5870 SW 8TH ST SUITE 08
-----------------------------------------------------
City | WEST MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33144-5052
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-403-2586
-----------------------------------------------------
Fax | 305-403-2640
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5870 SW 8TH ST SUITE 08
-----------------------------------------------------
City | WEST MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33144-5052
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-403-2586
-----------------------------------------------------
Fax | 305-403-2640
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT
-----------------------------------------------------
Name | MR. LUIZ MIGUEL DIAZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 786-356-9673
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------