Provider Demographics
NPI:1073241857
Name:RELISH LIFE PRACTITIONERS INC
Entity Type:Organization
Organization Name:RELISH LIFE PRACTITIONERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:NEVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-229-2146
Mailing Address - Street 1:122 15TH ST UNIT 746
Mailing Address - Street 2:
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-8040
Mailing Address - Country:US
Mailing Address - Phone:833-472-5474
Mailing Address - Fax:
Practice Address - Street 1:548 OCEAN VIEW AVE
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-8040
Practice Address - Country:US
Practice Address - Phone:833-472-5474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-10
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty