Healthcare Provider Details

I. General information

NPI: 1750037982
Provider Name (Legal Business Name): LOTUS WELLNESS INSTITUTE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2022
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date: 11/14/2024
Reactivation Date: 02/04/2025

III. Provider practice location address

10651 N KENDALL DR STE 100
MIAMI FL
33176-1573
US

IV. Provider business mailing address

10651 N KENDALL DR STE 100
MIAMI FL
33176-1573
US

V. Phone/Fax

Practice location:
  • Phone: 786-502-2454
  • Fax: 786-502-2454
Mailing address:
  • Phone: 786-502-2454
  • Fax: 786-502-2454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ERNESTO HERNANDEZ RODRIGUEZ
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 786-525-3887