| Life Line Medical Group Inc | |
|
12595 Sw 137th Ave Ste 206 Miami FL 33186-4221 | |
| (786) 474-0541 | |
| Not Available |
| Full Name | Life Line Medical Group Inc |
|---|---|
| Speciality | General Practice |
| Location | 12595 Sw 137th Ave Ste 206, Miami, Florida |
| Authorized Official Name and Position | Eulogio Emiliano Benitez (PRESIDENT) |
| Authorized Official Contact | 7864740541 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Life Line Medical Group Inc 12595 Sw 137th Ave Ste 206 Miami FL 33186-4221 Ph: (786) 474-0541 | Life Line Medical Group Inc 12595 Sw 137th Ave Ste 206 Miami FL 33186-4221 Ph: (786) 474-0541 |
| NPI Number | 1174122337 |
|---|---|
| Provider Enumeration Date | 10/20/2020 |
| Last Update Date | 10/20/2020 |
| Medicare PECOS PAC ID | 1557726510 |
|---|---|
| Medicare Enrollment ID | O20230426000629 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174122337 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Secondary |
| Provider Name | Marlen Rubiera |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528690609 PECOS PAC ID: 3476945288 Enrollment ID: I20220127001681 |
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