Provider Demographics
NPI:1043012842
Name:HEALTHY LIFE MEDICAL PRACTICE. LLC
Entity type:Organization
Organization Name:HEALTHY LIFE MEDICAL PRACTICE. LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MD DIRECTOR/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LUZ
Authorized Official - Middle Name:PATRICIA
Authorized Official - Last Name:MORALES GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-946-4546
Mailing Address - Street 1:5925 IMPERIAL PKWY STE 117
Mailing Address - Street 2:
Mailing Address - City:MULBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:33860-8692
Mailing Address - Country:US
Mailing Address - Phone:863-304-5151
Mailing Address - Fax:
Practice Address - Street 1:5925 IMPERIAL PKWY STE 117
Practice Address - Street 2:
Practice Address - City:MULBERRY
Practice Address - State:FL
Practice Address - Zip Code:33860-8692
Practice Address - Country:US
Practice Address - Phone:863-304-5151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
No251J00000XAgenciesNursing Care
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service