1306034384 NPI number — HEALTHY LIFE PLUS, CORP.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306034384 NPI number — HEALTHY LIFE PLUS, CORP.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTHY LIFE PLUS, CORP.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306034384
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/09/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6555 NW 36TH ST
Provider Second Line Business Mailing Address:
SUITE B-108
Provider Business Mailing Address City Name:
VIRGINIA GARDENS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33166-6978
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
786-265-0565
Provider Business Mailing Address Fax Number:
786-265-0566

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6555 NW 36TH ST
Provider Second Line Business Practice Location Address:
SUITE B-108
Provider Business Practice Location Address City Name:
VIRGINIA GARDENS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33166-6978
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
786-265-0565
Provider Business Practice Location Address Fax Number:
786-265-0566
Provider Enumeration Date:
10/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PEREZ MARTINEZ
Authorized Official First Name:
YOEL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
786-265-0565

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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