Provider Demographics
NPI:1588035794
Name:LIFE MED CENTER ASSOC CORP.
Entity Type:Organization
Organization Name:LIFE MED CENTER ASSOC CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:O
Authorized Official - Last Name:GASCA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-762-2474
Mailing Address - Street 1:434 SW 12TH AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33130-2433
Mailing Address - Country:US
Mailing Address - Phone:786-762-2474
Mailing Address - Fax:786-953-5613
Practice Address - Street 1:7171 CORAL WAY STE 404
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-1693
Practice Address - Country:US
Practice Address - Phone:786-762-2474
Practice Address - Fax:786-953-5613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
FL261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care