Provider Demographics
NPI:1407918261
Name:LIFE MEDICAL INC
Entity Type:Organization
Organization Name:LIFE MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-884-0093
Mailing Address - Street 1:1350 PALM AVE
Mailing Address - Street 2:E
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-3454
Mailing Address - Country:US
Mailing Address - Phone:305-884-0093
Mailing Address - Fax:305-884-0096
Practice Address - Street 1:1350 PALM AVE
Practice Address - Street 2:E
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-3454
Practice Address - Country:US
Practice Address - Phone:305-884-0093
Practice Address - Fax:305-884-0096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies