Healthcare Provider Details

I. General information

NPI: 1164094876
Provider Name (Legal Business Name): NEW LIFE MEDICAL INSTITUTE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2021
Last Update Date: 07/13/2021
Certification Date: 07/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

861 SW 8TH ST
MIAMI FL
33130-3703
US

IV. Provider business mailing address

861 SW 8TH ST
MIAMI FL
33130-3703
US

V. Phone/Fax

Practice location:
  • Phone: 305-857-9800
  • Fax:
Mailing address:
  • Phone: 305-857-9800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: ERNESTO RODRIGUEZ
Title or Position: OWNER
Credential:
Phone: 305-857-9800