MEDICARE: NEW AGE HEALING CENTER, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1710420682
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW AGE HEALING CENTER, INC.

Provider Business Mailing Address
First Line	:	8408 WILSKY BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-1515
Country	:	US
Telephone Number	:	813-374-5887
Fax Number	:	813-374-6225

Provider Business Practice Location Address
First Line	:	8408 WILSKY BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-1515
Country	:	US
Telephone Number	:	813-374-5887
Fax Number	:	813-374-6225

Authorized Official
Title or Position	:	PRESIDENT
Name	:	EUSEBIO MANUEL AQUINO
Credential	:
Telephone Number	:	813-830-8193

Provider Enumeration Date	:	11/28/2016
Last Update Date	:	11/28/2016

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