Healthcare Provider Details

I. General information

NPI: 1497733067
Provider Name (Legal Business Name): NEW LIFE MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 09/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10300 SW 72ND ST SUITE 319
MIAMI FL
33173-3012
US

IV. Provider business mailing address

10300 SW 72ND ST SUITE 319
MIAMI FL
33173-3012
US

V. Phone/Fax

Practice location:
  • Phone: 305-271-6570
  • Fax: 305-279-6805
Mailing address:
  • Phone: 305-271-6570
  • Fax: 305-279-6805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License NumberHCC5621
License Number StateFL

VIII. Authorized Official

Name: LIZABETH C CALVEIRO
Title or Position: PRESIDENT
Credential:
Phone: 305-300-0004