Provider Demographics
NPI:1467851576
Name:CARE OF LIFE MEDICAL SERVICE CORP.
Entity Type:Organization
Organization Name:CARE OF LIFE MEDICAL SERVICE CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:305-644-2626
Mailing Address - Street 1:2140 W FLAGLER ST STE 209A
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-1642
Mailing Address - Country:US
Mailing Address - Phone:305-644-2626
Mailing Address - Fax:305-541-1736
Practice Address - Street 1:2140 W FLAGLER ST STE 209A
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-1642
Practice Address - Country:US
Practice Address - Phone:305-644-2626
Practice Address - Fax:305-541-1736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 67461261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service