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General NPI Number Information
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NPI Number | 1790828408
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Entity Type | Organization
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Legal Business Name | NEW LIFE INFUSION CENTER
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 06/25/2008
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Provider Practice Location Address
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Address Line | 1455 SW 27TH AVE
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City | MIAMI
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State | FL
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Zip | 33145-1234
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Country | US
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Telephone | 305-649-3260
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Fax | 305-649-3261
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Provider Business Mailing Address
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Address Line | 1455 SW 27TH AVE
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City | MIAMI
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State | FL
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Zip | 33145-1234
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Country | US
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Telephone | 305-649-3260
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Fax | 305-649-3261
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RAUL IGNACIO TANO
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Credential | M.D.
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Telephone | 305-649-3260
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QI0500X
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Taxonomy Name | Infusion Therapy Clinic/Center
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License Number | 170066-0002
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License Number State | FL
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