Organization
LONG LIFE MEDICAL INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ENRIQUE FRAXEDAS (PRESIDENT)
(305) 552-7723
Entity
Organization
Contact information
Practice address
2780 SW 87TH AVE, SUITE 104, MIAMI, FL 33165-3296
(305) 552-7723
(305) 552-7791
Mailing address
2780 SW 87 AVE, STE 104, MIAMI, FL 33165
(305) 552-7723
(305) 552-7791
Taxonomy
Speciality
Code
Description
License number
State
261QM3000X
Medically Fragile Infants and Children Day Care
Primary
MCC4499
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
34637
BCBSF
—
Enumeration date
02/17/2006
Last updated
03/28/2008
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