Provider Demographics
NPI:1861007346
Name:DELUXE LIFE MEDICAL GROUP CORP
Entity Type:Organization
Organization Name:DELUXE LIFE MEDICAL GROUP CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V- PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOMINGO
Authorized Official - Middle Name:
Authorized Official - Last Name:MORELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-851-1260
Mailing Address - Street 1:4017 SW 152ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-5919
Mailing Address - Country:US
Mailing Address - Phone:786-409-5295
Mailing Address - Fax:786-703-7908
Practice Address - Street 1:4017 SW 152ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33185-5919
Practice Address - Country:US
Practice Address - Phone:786-409-5295
Practice Address - Fax:786-703-7908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)