Healthcare Provider Details

I. General information

NPI: 1912820721
Provider Name (Legal Business Name): LAVITA CAFE CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4306 LEE BLVD
LEHIGH ACRES FL
33971-1726
US

IV. Provider business mailing address

4306 LEE BLVD
LEHIGH ACRES FL
33971-1726
US

V. Phone/Fax

Practice location:
  • Phone: 239-491-2018
  • Fax:
Mailing address:
  • Phone: 239-491-2018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MAIKOL DEL SOL
Title or Position: OWNER
Credential:
Phone: 239-302-9545