Provider Demographics
NPI:1235970286
Name:LS RADIANTLIFE HEALTH SERVICES LLC
Entity type:Organization
Organization Name:LS RADIANTLIFE HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LIN
Authorized Official - Middle Name:MARGARET
Authorized Official - Last Name:CHU JOY DAVILA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:939-216-3292
Mailing Address - Street 1:PO BOX 1503
Mailing Address - Street 2:
Mailing Address - City:FAJARDO
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00738
Mailing Address - Country:UM
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:URB VEVE CALZADA
Practice Address - Street 2:CALLE 3A O28
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738
Practice Address - Country:US
Practice Address - Phone:939-216-3292
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty