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General NPI Number Information
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NPI Number | 1568029718
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Entity Type | Organization
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Legal Business Name | HEALTHY LIFE ENTERPRISES LLC
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Dates
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Enumeration Date | 05/23/2019
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Last Update Date | 05/23/2019
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Provider Practice Location Address
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Address Line | 6041 KIMBERLY BLVD STE K
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City | NORTH LAUDERDALE
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State | FL
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Zip | 33068-2816
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Country | US
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Telephone | 954-906-4141
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Fax |
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Provider Business Mailing Address
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Address Line | 6041 KIMBERLY BLVD STE K
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City | NORTH LAUDERDALE
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State | FL
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Zip | 33068-2816
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Country | US
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Telephone | 954-906-4141
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | JORGE PENA
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Credential |
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Telephone | 954-906-4141
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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