Provider Demographics
NPI:1639410533
Name:FIT-LIFE ENTERPRISES
Entity Type:Organization
Organization Name:FIT-LIFE ENTERPRISES
Other - Org Name:FIT-LIFE MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:OEMIL
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-701-5689
Mailing Address - Street 1:10103 W LOOP 1604 N
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78254-9715
Mailing Address - Country:US
Mailing Address - Phone:210-701-5689
Mailing Address - Fax:
Practice Address - Street 1:10103 W LOOP 1604 N
Practice Address - Street 2:SUITE 105
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78254-9715
Practice Address - Country:US
Practice Address - Phone:210-701-5689
Practice Address - Fax:210-701-5689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-03
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP0708207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty