Provider Demographics
NPI:1952631830
Name:NEW LIFE MEDICAL CONSULTANTS
Entity Type:Organization
Organization Name:NEW LIFE MEDICAL CONSULTANTS
Other - Org Name:RADIANCEMD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SANCHEZ-GOETTLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-816-3091
Mailing Address - Street 1:3300 NW 185TH AVE # 384
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-3406
Mailing Address - Country:US
Mailing Address - Phone:503-816-3091
Mailing Address - Fax:
Practice Address - Street 1:14126 NW DUNBAR LN
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97231
Practice Address - Country:US
Practice Address - Phone:503-816-3091
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-28
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2009-0469207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty