Provider Demographics
NPI:1477765386
Name:ZOE LIFE WELLNESS CENTER, PA
Entity Type:Organization
Organization Name:ZOE LIFE WELLNESS CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LETOSHA
Authorized Official - Middle Name:EVETTE
Authorized Official - Last Name:GALE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-238-5433
Mailing Address - Street 1:PO BOX 881
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-0023
Mailing Address - Country:US
Mailing Address - Phone:281-238-5433
Mailing Address - Fax:281-239-0235
Practice Address - Street 1:1601 MAIN ST
Practice Address - Street 2:SUITE 502
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-3247
Practice Address - Country:US
Practice Address - Phone:281-238-5433
Practice Address - Fax:281-239-0235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8624207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00X881Medicare PIN