Organization
THE LIFE CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROXANA ESTEVEZ SILVA SR. (PRESIDENT)
(305) 303-1638
Entity
Organization
Contact information
Practice address
1 E BROWARD BLVD STE 700, FT LAUDERDALE, FL 33301-1876
(954) 606-5370
(954) 337-8485
Mailing address
9367 FONTAINEBLEAU BLVD APT G111, MIAMI, FL 33172-5636
(305) 303-1638
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
09/09/2020
Last updated
12/16/2020
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