Provider Demographics
NPI:1821789603
Name:LIFETREE HEALTHCARE INC
Entity Type:Organization
Organization Name:LIFETREE HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:TIONGSON
Authorized Official - Last Name:ENRILE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-809-2437
Mailing Address - Street 1:13750 VICTORY BLVD
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-2324
Mailing Address - Country:US
Mailing Address - Phone:818-809-2437
Mailing Address - Fax:818-809-2427
Practice Address - Street 1:13750 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-2324
Practice Address - Country:US
Practice Address - Phone:818-809-2437
Practice Address - Fax:818-809-2427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty