Provider Demographics
NPI:1518714591
Name:PRO LIFE HEALTH MEDICAL CENTER LLC
Entity type:Organization
Organization Name:PRO LIFE HEALTH MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BETSABE
Authorized Official - Middle Name:
Authorized Official - Last Name:ZALDIVAR
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:786-616-1427
Mailing Address - Street 1:12985 SW 130TH CT UNIT 105
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-5344
Mailing Address - Country:US
Mailing Address - Phone:786-616-1427
Mailing Address - Fax:
Practice Address - Street 1:12985 SW 130TH CT UNIT 105
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-5344
Practice Address - Country:US
Practice Address - Phone:786-616-1427
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health