Provider Demographics
NPI:1134734056
Name:THE LIFE CLINIC LLC
Entity type:Organization
Organization Name:THE LIFE CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROXANA
Authorized Official - Middle Name:
Authorized Official - Last Name:ESTEVEZ SILVA
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:305-303-1638
Mailing Address - Street 1:9367 FONTAINEBLEAU BLVD APT G111
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-5636
Mailing Address - Country:US
Mailing Address - Phone:305-303-1638
Mailing Address - Fax:
Practice Address - Street 1:1 E BROWARD BLVD STE 700
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-1876
Practice Address - Country:US
Practice Address - Phone:954-606-5370
Practice Address - Fax:954-337-8485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-09
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management