Provider Demographics
NPI:1578014353
Name:LIFE & HEALTH PROFESSIONAL SERVICE, INC.
Entity Type:Organization
Organization Name:LIFE & HEALTH PROFESSIONAL SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:L
Authorized Official - Last Name:DELGADO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-884-3065
Mailing Address - Street 1:PO BOX 77
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-0077
Mailing Address - Country:US
Mailing Address - Phone:787-884-3065
Mailing Address - Fax:787-854-1687
Practice Address - Street 1:B24 CALLE 3
Practice Address - Street 2:URBANIZACION FLAMBOYAN
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-5409
Practice Address - Country:US
Practice Address - Phone:787-884-3065
Practice Address - Fax:787-854-1687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-17
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRC44793Medicare UPIN