Healthcare Provider Details

I. General information

NPI: 1770443632
Provider Name (Legal Business Name): LUMINA CARE MEDICAL GROUP PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2025
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

633 NE 167TH ST
MIAMI FL
33162-2442
US

IV. Provider business mailing address

885 3RD AVE FL 28
NEW YORK NY
10022-4834
US

V. Phone/Fax

Practice location:
  • Phone: 929-650-3990
  • Fax:
Mailing address:
  • Phone: 929-650-3990
  • Fax: 929-996-6230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: FAIGA MILLER
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 929-650-3990