Provider Demographics
NPI:1659648848
Name:LIFE & HOPE MEDICAL CENTER INC
Entity Type:Organization
Organization Name:LIFE & HOPE MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:I
Authorized Official - Credentials:MASSAGE THERAPIST
Authorized Official - Phone:239-821-0713
Mailing Address - Street 1:28321 S TAMIAMI TRL # A3
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34134-3226
Mailing Address - Country:US
Mailing Address - Phone:239-821-0713
Mailing Address - Fax:305-220-5015
Practice Address - Street 1:28321 S TAMIAMI TRL # A3
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-3226
Practice Address - Country:US
Practice Address - Phone:239-821-0713
Practice Address - Fax:305-220-5015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-16
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA60379261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty