Healthcare Provider Details

I. General information

NPI: 1386700912
Provider Name (Legal Business Name): NEW LIFE POLYCLINICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 08/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 HOOK SQ
MIAMI SPRINGS FL
33166-4401
US

IV. Provider business mailing address

61 HOOK SQ
MIAMI SPRINGS FL
33166-4401
US

V. Phone/Fax

Practice location:
  • Phone: 305-884-8880
  • Fax: 305-884-7740
Mailing address:
  • Phone: 305-884-8880
  • Fax: 305-884-7740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberHCC7720
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARIA TERESA COLUMBIE
Title or Position: PRESIDENT
Credential:
Phone: 305-884-8880