| Lifephysician, LLC | |
|
999 Waterside Dr Ste 2525 Norfolk VA 23510-3316 | |
| (925) 824-3198 | |
| (949) 655-8602 |
| Full Name | Lifephysician, LLC |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 999 Waterside Dr Ste 2525, Norfolk, Virginia |
| Authorized Official Name and Position | Amanda V. Chance (OWNER) |
| Authorized Official Contact | 6462511992 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lifephysician, LLC 5030 E Lakeshore Dr San Ramon CA 94582-4822 Ph: (646) 251-1992 | Lifephysician, LLC 999 Waterside Dr Ste 2525 Norfolk VA 23510-3316 Ph: (925) 824-3198 |
| NPI Number | 1194336313 |
|---|---|
| Provider Enumeration Date | 08/11/2020 |
| Last Update Date | 08/11/2020 |
| Certification Date | 08/11/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194336313 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (NU) | Primary |
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