Healthcare Provider Details

I. General information

NPI: 1568118313
Provider Name (Legal Business Name): LIGHTHOUSE WELLNESS CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2022
Last Update Date: 03/01/2022
Certification Date: 03/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 N MAIN ST
BRANFORD CT
06405-3072
US

IV. Provider business mailing address

141 N MAIN ST
BRANFORD CT
06405-3072
US

V. Phone/Fax

Practice location:
  • Phone: 203-399-2123
  • Fax:
Mailing address:
  • Phone: 203-399-2123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. FRANCISCO RIVERA FERRERA
Title or Position: OWNER
Credential: MD
Phone: 203-399-2123