Provider Demographics
NPI:1952108375
Name:MTF HEALTHY LIVING, LLC
Entity type:Organization
Organization Name:MTF HEALTHY LIVING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:FLORENTINO
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:626-278-8371
Mailing Address - Street 1:8605 SANTA MONICA BLVD STE 93295
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90069-4109
Mailing Address - Country:US
Mailing Address - Phone:626-278-8371
Mailing Address - Fax:
Practice Address - Street 1:144 S MAIN ST
Practice Address - Street 2:STE 100
Practice Address - City:ALPINE
Practice Address - State:UT
Practice Address - Zip Code:84004-1667
Practice Address - Country:US
Practice Address - Phone:626-278-8371
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-25
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center