Provider Demographics
NPI:1083128102
Name:NEW LIFE MEDICAL SUPPLIES, LLC
Entity Type:Organization
Organization Name:NEW LIFE MEDICAL SUPPLIES, LLC
Other - Org Name:NEW LIFE MEDICAL SUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / GM
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SILVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-663-8035
Mailing Address - Street 1:925 B ST STE 304
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-4628
Mailing Address - Country:US
Mailing Address - Phone:800-903-6171
Mailing Address - Fax:800-903-7116
Practice Address - Street 1:925 B ST STE 304
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-4628
Practice Address - Country:US
Practice Address - Phone:800-903-6171
Practice Address - Fax:800-903-7116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-28
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA97340332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies