Provider Demographics
NPI:1255990750
Name:HEALTHY LIFE MEDICAL CENTER INC
Entity type:Organization
Organization Name:HEALTHY LIFE MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAYCO
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-200-3615
Mailing Address - Street 1:85 GRAND CANAL DR STE 207
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-2564
Mailing Address - Country:US
Mailing Address - Phone:305-200-3615
Mailing Address - Fax:305-699-0575
Practice Address - Street 1:85 GRAND CANAL DR STE 207
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2564
Practice Address - Country:US
Practice Address - Phone:305-200-3615
Practice Address - Fax:305-699-0575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-07
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty