Provider Demographics
NPI:1033295522
Name:LIFE HEALTH CARE GROUP, INC.
Entity Type:Organization
Organization Name:LIFE HEALTH CARE GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:TIONGSON
Authorized Official - Last Name:ENRILE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-989-9700
Mailing Address - Street 1:14540 VICTORY BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-1600
Mailing Address - Country:US
Mailing Address - Phone:818-989-9700
Mailing Address - Fax:818-989-9705
Practice Address - Street 1:14540 VICTORY BLVD
Practice Address - Street 2:STE 100
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-1600
Practice Address - Country:US
Practice Address - Phone:818-989-9700
Practice Address - Fax:818-989-9705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA29539207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA29539OtherLICENSE