Provider Demographics
NPI:1407927684
Name:ENHANCING LIFESTYLES, INC.
Entity Type:Organization
Organization Name:ENHANCING LIFESTYLES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTEREDLICENSED DIETITIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:RAQUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CORDOVES
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LDN
Authorized Official - Phone:954-816-6198
Mailing Address - Street 1:2806 NW 48TH ST
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33309-2941
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2806 NW 48TH ST
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33309-2941
Practice Address - Country:US
Practice Address - Phone:954-816-6198
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND 3415261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health