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General NPI Number Information
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NPI Number | 1508053091
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Entity Type | Organization
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Legal Business Name | NEW AGE MEDICAL CENTER
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Dates
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Enumeration Date | 09/27/2007
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Last Update Date | 07/20/2010
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Provider Practice Location Address
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Address Line | 12142 CORTEZ BLVD
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City | BROOKSVILLE
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State | FL
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Zip | 34613
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Country | US
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Telephone | 352-596-9095
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Fax | 352-596-9271
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Provider Business Mailing Address
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Address Line | 12142 CORTEZ BLVD
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City | BROOKSVILLE
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State | FL
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Zip | 34613
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Country | US
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Telephone | 352-596-9095
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Fax | 352-596-9271
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Authorized Official
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Title or Position | VICE-PRESIDENT
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Name | DORIS CARMEN CIFUENTES
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Credential | M.D.
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Telephone | 352-596-9095
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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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