Provider Demographics
NPI:1285650895
Name:NEW LIFE MEDICAL GROUP INC
Entity Type:Organization
Organization Name:NEW LIFE MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:F
Authorized Official - Last Name:CABRERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-631-4081
Mailing Address - Street 1:1835 W FLAGLER ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-1917
Mailing Address - Country:US
Mailing Address - Phone:305-631-4081
Mailing Address - Fax:305-631-4083
Practice Address - Street 1:1835 W FLAGLER ST
Practice Address - Street 2:SUITE 6
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-1917
Practice Address - Country:US
Practice Address - Phone:305-631-4081
Practice Address - Fax:305-631-4083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC6823208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK9387Medicare ID - Type UnspecifiedMEDICARE PROVIDER