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General NPI Number Information
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NPI Number | 1750416400
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Entity Type | Organization
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Legal Business Name | HEALTHY LIFE FAMILY MEDICINE, PLC
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Dates
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Enumeration Date | 02/22/2007
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Last Update Date | 05/22/2019
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Provider Practice Location Address
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Address Line | 750 N ESTRELLA PKWY SUITE 40
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City | GOODYEAR
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State | AZ
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Zip | 85338-9272
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Country | US
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Telephone | 602-574-1890
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5204
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City | GOODYEAR
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State | AZ
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Zip | 85338-0603
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. JOHN MONROE
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Credential | MD
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Telephone | 602-574-1890
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 35067
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License Number State | AZ
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