Provider Demographics
NPI:1497733067
Name:NEW LIFE MEDICAL CENTER INC
Entity Type:Organization
Organization Name:NEW LIFE MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LIZABETH
Authorized Official - Middle Name:C
Authorized Official - Last Name:CALVEIRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-300-0004
Mailing Address - Street 1:10300 SW 72ND ST
Mailing Address - Street 2:SUITE 319
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3012
Mailing Address - Country:US
Mailing Address - Phone:305-271-6570
Mailing Address - Fax:305-279-6805
Practice Address - Street 1:10300 SW 72ND ST
Practice Address - Street 2:SUITE 319
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3012
Practice Address - Country:US
Practice Address - Phone:305-271-6570
Practice Address - Fax:305-279-6805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-04
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X, 208D00000X, 261QA1903X
FLHCC5621261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK6149Medicare PIN