Life Blue Medical Center Corp

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

HCC11034 Issued in FL

Legal business name

LIFE BLUE MEDICAL CENTER CORP

Practice address

12260 SW 8TH St Ste 230
Miami, FL 33184-1549

Phone

(305) 456-5380

Fax

(305) 631-2638

NPI assigned

May 22, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Maria C Hernandez

Title

Owner

Phone

(305) 456-5380

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1495411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1558898577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12260 SW 8TH ST STE 230",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331841549",
            "telephone_number": "305-456-5380",
            "fax_number": "305-631-2638"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12260 SW 8TH ST STE 230",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331841549",
            "telephone_number": "305-456-5380",
            "fax_number": "305-631-2638"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE BLUE MEDICAL CENTER CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-22",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "HERNANDEZ",
        "authorized_official_first_name": "MARIA",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "305-456-5380"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "FL",
            "license": "HCC11034",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Life Enhancement
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• Physical Medicine & Rehabilitation Physician in Miami, FL
• Providers in Miami, FL by specialty
• Physical Medicine & Rehabilitation Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.