Provider Demographics
NPI:1427607944
Name:HEALTHLIFE CORPORATION
Entity type:Organization
Organization Name:HEALTHLIFE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HUMBERTO
Authorized Official - Middle Name:LORENZO
Authorized Official - Last Name:PAEZ
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:786-247-3757
Mailing Address - Street 1:4205 SW 136TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-3751
Mailing Address - Country:US
Mailing Address - Phone:786-247-3757
Mailing Address - Fax:
Practice Address - Street 1:4205 SW 136TH PL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-3751
Practice Address - Country:US
Practice Address - Phone:786-247-3757
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-06
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty