Healthcare Provider Details

I. General information

NPI: 1356943609
Provider Name (Legal Business Name): NEW LIFE MED CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2020
Last Update Date: 12/14/2021
Certification Date: 12/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5801 NW 151ST ST STE 106
MIAMI LAKES FL
33014-2437
US

IV. Provider business mailing address

5801 NW 151ST ST STE 106
MIAMI LAKES FL
33014-2437
US

V. Phone/Fax

Practice location:
  • Phone: 305-640-8393
  • Fax: 305-639-8314
Mailing address:
  • Phone: 305-951-8639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: YUSLEY COUCEIRO
Title or Position: MGRM
Credential: APRN
Phone: 305-640-8393