Provider Demographics
NPI:1639636541
Name:HEALTHY BODY FACTORY, INC
Entity Type:Organization
Organization Name:HEALTHY BODY FACTORY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LIZMARY
Authorized Official - Middle Name:
Authorized Official - Last Name:NAZARIO-IRIZARRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-616-2373
Mailing Address - Street 1:HC 1 BOX 7365
Mailing Address - Street 2:
Mailing Address - City:LAJAS
Mailing Address - State:PR
Mailing Address - Zip Code:00667-9066
Mailing Address - Country:US
Mailing Address - Phone:787-616-2373
Mailing Address - Fax:787-899-2836
Practice Address - Street 1:CARR 315 KM 1.3 BO SABANA YEGUAS
Practice Address - Street 2:
Practice Address - City:LAJAS
Practice Address - State:PR
Practice Address - Zip Code:00667-9066
Practice Address - Country:US
Practice Address - Phone:787-616-2373
Practice Address - Fax:787-899-2836
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTHY BODY FACTORY INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-02-27
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty