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General NPI Number Information
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NPI Number | 1376357939
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Entity Type | Organization
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Legal Business Name | ETERNAL LIFE MEDICAL CENTER LLC
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Dates
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Enumeration Date | 02/04/2025
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Last Update Date | 02/04/2025
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Provider Practice Location Address
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Address Line | 7382 NW 35TH TER STE 106
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City | MIAMI
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State | FL
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Zip | 33122-1241
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Country | US
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Telephone | 786-306-3507
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Fax |
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Provider Business Mailing Address
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Address Line | 9207 SW 147TH CT
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City | MIAMI
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State | FL
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Zip | 33196-4112
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Country | US
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Telephone | 786-306-3507
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | LEANDRO JAVIER CORBELLE
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Credential |
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Telephone | 786-306-3507
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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