Healthcare Provider Details

I. General information

NPI: 1184542946
Provider Name (Legal Business Name): LUXORA ELITE MEDICAL & WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18300 NW 62ND AVE STE 210
MIAMI GARDENS FL
33015-8207
US

IV. Provider business mailing address

18300 NW 62ND AVE STE 210
MIAMI GARDENS FL
33015-8207
US

V. Phone/Fax

Practice location:
  • Phone: 305-300-5338
  • Fax:
Mailing address:
  • Phone: 305-300-5338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. ODALIS MARRERO
Title or Position: OWNER
Credential: APRN
Phone: 305-300-5338