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General NPI Number Information
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NPI Number | 1447199724
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Entity Type | Organization
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Legal Business Name | LIFE ONCOLOGIA
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Dates
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Enumeration Date | 03/25/2026
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Last Update Date | 03/25/2026
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Provider Practice Location Address
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Address Line | COL CIUDAD DEL SOL
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City | ZAPOPAN
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State | JALISCO
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Zip | 45050
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Country | MX
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Telephone |
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Fax |
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Provider Business Mailing Address
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Address Line | 500 WESTOVER DR # 19593
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City | SANFORD
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State | NC
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Zip | 27330-8941
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Country | US
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Telephone | 801-896-1611
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Fax |
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Authorized Official
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Title or Position | MGR
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Name | JAVIER EZQUERRA GOMEZ
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Credential |
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Telephone | 801-896-1611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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