Provider Demographics
NPI:1962455097
Name:NEW LIFE OBSTETRICAL CARE INC
Entity Type:Organization
Organization Name:NEW LIFE OBSTETRICAL CARE INC
Other - Org Name:NEW LIFE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LUCIANO
Authorized Official - Middle Name:AUGUSTINE
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:813-239-9166
Mailing Address - Street 1:400 EAST MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603
Mailing Address - Country:US
Mailing Address - Phone:813-239-9166
Mailing Address - Fax:813-239-3011
Practice Address - Street 1:400 EAST MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603
Practice Address - Country:US
Practice Address - Phone:813-239-9166
Practice Address - Fax:813-239-3011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0032863207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL042377700Medicaid
FL064971600Medicaid
FL374439600Medicaid