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General NPI Number Information
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NPI Number | 1356943609
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Entity Type | Organization
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Legal Business Name | NEW LIFE MED CENTER LLC
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Dates
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Enumeration Date | 11/11/2020
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Last Update Date | 12/14/2021
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Provider Practice Location Address
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Address Line | 5801 NW 151ST ST STE 106
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City | MIAMI LAKES
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State | FL
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Zip | 33014-2437
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Country | US
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Telephone | 305-640-8393
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Fax | 305-639-8314
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Provider Business Mailing Address
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Address Line | 5801 NW 151ST ST STE 106
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City | MIAMI LAKES
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State | FL
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Zip | 33014-2437
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Country | US
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Telephone | 305-951-8639
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Fax |
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Authorized Official
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Title or Position | MGRM
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Name | YUSLEY COUCEIRO
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Credential | APRN
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Telephone | 305-640-8393
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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