Provider Demographics
NPI:1851988158
Name:NEW LIFE MEDICAL RESEARCH CENTER INC
Entity Type:Organization
Organization Name:NEW LIFE MEDICAL RESEARCH CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:MR
Authorized Official - First Name:REYMUNDO
Authorized Official - Middle Name:
Authorized Official - Last Name:SILVA
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:786-508-3521
Mailing Address - Street 1:3750 W 16TH AVE STE 226U
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-4648
Mailing Address - Country:US
Mailing Address - Phone:786-360-3750
Mailing Address - Fax:
Practice Address - Street 1:3750 W 16TH AVE STE 226U
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-4648
Practice Address - Country:US
Practice Address - Phone:786-360-3750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11007600OtherLICENSE