Provider Demographics
NPI:1760202840
Name:HEALTHY LIFE MEDICAL CLINIC
Entity type:Organization
Organization Name:HEALTHY LIFE MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KARAMO
Authorized Official - Middle Name:
Authorized Official - Last Name:CHILOMBO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-392-4040
Mailing Address - Street 1:2521 W BURBANK BLVD
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-2302
Mailing Address - Country:US
Mailing Address - Phone:818-392-4040
Mailing Address - Fax:818-392-4042
Practice Address - Street 1:2521 W BURBANK BLVD
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-2302
Practice Address - Country:US
Practice Address - Phone:818-392-4040
Practice Address - Fax:818-392-4042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-14
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty