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General NPI Number Information
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NPI Number | 1952108375
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Entity Type | Organization
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Legal Business Name | MTF HEALTHY LIVING, LLC
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Dates
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Enumeration Date | 02/25/2025
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Last Update Date | 04/18/2025
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Provider Practice Location Address
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Address Line | 144 S MAIN ST STE 100
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City | ALPINE
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State | UT
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Zip | 84004-1667
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Country | US
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Telephone | 626-278-8371
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Fax |
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Provider Business Mailing Address
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Address Line | 8605 SANTA MONICA BLVD STE 93295
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City | WEST HOLLYWOOD
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State | CA
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Zip | 90069-4109
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Country | US
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Telephone | 626-278-8371
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | MARK FLORENTINO
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Credential | NP
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Telephone | 626-278-8371
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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