MEDICARE: HEALTH AND LIFE HEALTHCARE CENTER 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	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1932848959
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTH AND LIFE HEALTHCARE CENTER LLC

Provider Business Mailing Address
First Line	:	2217 GLEN HEATHER WAY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-4446
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2217 GLEN HEATHER WAY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-4446
Country	:	US
Telephone Number	:	702-980-2585
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ALAIN GONZALEZ
Credential	:
Telephone Number	:	702-980-2585

Provider Enumeration Date	:	05/27/2022
Last Update Date	:	05/27/2022

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