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General NPI Number Information
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NPI Number | 1689965055
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Entity Type | Organization
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Legal Business Name | HEAVEN ON EARTH HEALTHY LIFE
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Dates
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Enumeration Date | 04/20/2011
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Last Update Date | 04/20/2011
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Provider Practice Location Address
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Address Line | 305 N LAKEMONT AVE 305 N. LAKEMONT AVE
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City | WINTER PARK
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State | FL
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Zip | 32792-3204
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Country | US
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Telephone | 407-222-3069
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Fax |
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Provider Business Mailing Address
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Address Line | 305 N LAKEMONT AVE 305 N. LAKEMONT AVE
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City | WINTER PARK
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State | FL
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Zip | 32792-3204
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Country | US
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Telephone | 407-222-3069
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | PAOLA MENDOZA
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Credential |
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Telephone | 407-222-3069
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number | MA 50907
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License Number State | FL
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