Healthcare Provider Details

I. General information

NPI: 1871424820
Provider Name (Legal Business Name): NEW LIFE DERMATOLOGY A PROFESSIONAL MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 SHEPARD DR STE 204
SANTA MARIA CA
93454-7016
US

IV. Provider business mailing address

1505 SHEPARD DR STE 204
SANTA MARIA CA
93454-7016
US

V. Phone/Fax

Practice location:
  • Phone: 805-478-6570
  • Fax: 866-317-4919
Mailing address:
  • Phone: 805-478-6570
  • Fax: 866-317-4919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM ALLEN OKERBLOM
Title or Position: PRESIDENT
Credential: OKERBLOM
Phone: 805-478-6570