MEDICARE: NULIFE DIALYSIS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801263009
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NULIFE DIALYSIS, INC.

Provider Business Mailing Address
First Line	:	4805 NW 183 STREET
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33055
Country	:	US
Telephone Number	:	305-952-4925
Fax Number	:	786-657-2801

Provider Business Practice Location Address
First Line	:	4805 NW 183RD ST
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33055-2955
Country	:	US
Telephone Number	:	305-952-4925
Fax Number	:	786-657-2801

Authorized Official
Title or Position	:	OWNER
Name	:	LAZARO B RAMOS
Credential	:
Telephone Number	:	786-414-9291

Provider Enumeration Date	:	08/24/2015
Last Update Date	:	08/24/2015

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Directions to “NULIFE DIALYSIS, INC. ” Practice Location

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