MEDICARE: LUMARHEALTHCARESERVICES.INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	305R00000X	Preferred Provider Organization	232190	FL

General Provider Information

NPI Number	:	1336433648
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUMARHEALTHCARESERVICES.INC

Provider Business Mailing Address
First Line	:	10625 HAMMOCKS BLVD APT 528
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33196-2642
Country	:	US
Telephone Number	:	305-491-3203
Fax Number	:

Provider Business Practice Location Address
First Line	:	4595 SW 139TH CT APT A
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33175-4454
Country	:	US
Telephone Number	:	305-491-3203
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. LOURDES NIEVES
Credential	:
Telephone Number	:	305-491-3203

Provider Enumeration Date	:	06/03/2011
Last Update Date	:	06/03/2011

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Directions to “LUMARHEALTHCARESERVICES.INC ” Practice Location

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