Basic Information
| Provider Information | |||||||||
| NPI: | 1710114483 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEW LIFE OB/GYN, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7150 W 20TH AVE | ||||||||
| Address2: | SUITE 615 | ||||||||
| City: | HIALEAH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330165529 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3058223044 | ||||||||
| FaxNumber: | 3058178309 | ||||||||
| Practice Location | |||||||||
| Address1: | 7150 W 20TH AVE | ||||||||
| Address2: | SUITE 615 | ||||||||
| City: | HIALEAH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330165529 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3058223044 | ||||||||
| FaxNumber: | 3058178309 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2009 | ||||||||
| LastUpdateDate: | 06/19/2009 | ||||||||
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| AuthorizedOfficialLastName: | FERRARA | ||||||||
| AuthorizedOfficialFirstName: | HUGO | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3058223044 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | FLORIDA WOMEN CARE, LLC | ||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QH0100X | ME52907 | FL | Y | Ambulatory Health Care Facilities | Clinic/Center | Health Service |
No ID Information.