Provider Demographics
NPI:1457946485
Name:HEALTH&LIFE EVOLUTION LLC
Entity Type:Organization
Organization Name:HEALTH&LIFE EVOLUTION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:JOSUE
Authorized Official - Last Name:VALLENILLA
Authorized Official - Suffix:
Authorized Official - Credentials:SA-C
Authorized Official - Phone:407-272-8505
Mailing Address - Street 1:14047 WALCOTT AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32827-7471
Mailing Address - Country:US
Mailing Address - Phone:407-272-8505
Mailing Address - Fax:
Practice Address - Street 1:14047 WALCOTT AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32827-7471
Practice Address - Country:US
Practice Address - Phone:407-272-8505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-02
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty