Healthcare Provider Details

I. General information

NPI: 1659794766
Provider Name (Legal Business Name): NEW FOUND LIFE OF DELRAY BEACH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2014
Last Update Date: 01/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 NE 5TH AVE SUITE 103-104
DELRAY BEACH FL
33483-5530
US

IV. Provider business mailing address

210 NE 6TH AVE 103-104
DELRAY BEACH FL
33483-5540
US

V. Phone/Fax

Practice location:
  • Phone: 561-270-2361
  • Fax: 561-270-2081
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number800027026
License Number StateFL

VIII. Authorized Official

Name: ANGELA IACULLO
Title or Position: BIRECTOR OF BILLING
Credential:
Phone: 561-270-2361