Organization
LA VIDA EN EL MAR ALF
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LUIS Y FUENTES JR. LUIS (ADMINISTRATOR)
(813) 770-0340
Entity
Organization
Contact information
Practice address
6802 ROSEWOOD CT, TAMPA, FL 33615-3318
(786) 488-1075
(813) 885-3810
Mailing address
6802 ROSEWOOD CT, TAMPA, FL 33615-3318
(786) 488-1075
(813) 885-3810
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
AL12627
FL
Other
Enumeration date
03/03/2015
Last updated
03/03/2015
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