# GREAT LIFE MEDICAL CENTER LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1487351854
- **Authorized official:** IROSBEL REYES - BLANCO (CEO)
- **Authorized official phone:** (702) 596-6451

## Contact information

- **Practice address:** 1579 FALLING LEAF LN, LAS VEGAS, NV 89142-1100
- **Practice address phone:** (702) 596-6451
- **Mailing address:** 1579 FALLING LEAF LN, LAS VEGAS, NV 89142-1100

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 02/15/2023
- **Last updated:** 02/15/2023