Healthcare Provider Details

I. General information

NPI: 1598148629
Provider Name (Legal Business Name): NEW LIFE IMAGING INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2015
Last Update Date: 07/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25021 MADISON AVE SUITE 105
MURRIETA CA
92562-8997
US

IV. Provider business mailing address

25021 MADISON AVE SUITE 105
MURRIETA CA
92562-8997
US

V. Phone/Fax

Practice location:
  • Phone: 951-894-6539
  • Fax:
Mailing address:
  • Phone: 951-894-6539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License NumberC3783794
License Number StateCA

VIII. Authorized Official

Name: DANA NOEL MARCOS
Title or Position: OWNER
Credential: DMS
Phone: 951-489-9096