Provider Demographics
NPI:1790828408
Name:NEW LIFE INFUSION CENTER
Entity Type:Organization
Organization Name:NEW LIFE INFUSION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:IGNACIO
Authorized Official - Last Name:TANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-649-3260
Mailing Address - Street 1:1455 SW 27TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-1234
Mailing Address - Country:US
Mailing Address - Phone:305-649-3260
Mailing Address - Fax:305-649-3261
Practice Address - Street 1:1455 SW 27TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145-1234
Practice Address - Country:US
Practice Address - Phone:305-649-3260
Practice Address - Fax:305-649-3261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL170066-0002261QI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL044443000Medicaid
FL201711294OtherTAX ID NUMBER
FL201711294OtherTAX ID NUMBER