MEDICARE: ASHALIFESTYLE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WG0000X	General Practice Registered Nurse

General Provider Information

NPI Number	:	1265378608
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASHALIFESTYLE LLC

Provider Business Mailing Address
First Line	:	27242 CALLE ALTA VIS
Second Line	:
City	:	CAPO BEACH
State	:	CA
Zip	:	92624-1050
Country	:	US
Telephone Number	:	909-223-9526
Fax Number	:	909-223-9526

Provider Business Practice Location Address
First Line	:	27242 CALLE ALTA VIS
Second Line	:
City	:	CAPO BEACH
State	:	CA
Zip	:	92624-1050
Country	:	US
Telephone Number	:	909-223-9526
Fax Number	:	909-223-9526

Authorized Official
Title or Position	:	ASHALIFESTYLE LLC
Name	:	AMY MARIE PEREZ
Credential	:	RN
Telephone Number	:	909-223-9526

Provider Enumeration Date	:	04/27/2026
Last Update Date	:	04/27/2026

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