Healthcare Provider Details

I. General information

NPI: 1073431193
Provider Name (Legal Business Name): VIDALUX MIND AND WELLNESS GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

3669 NW 18TH ST
MIAMI FL
33125-1753
US

IV. Provider business mailing address

11752 SW 187TH TER
MIAMI FL
33177-3219
US

V. Phone/Fax

Practice location:
  • Phone: 305-728-9834
  • Fax:
Mailing address:
  • Phone: 305-728-9834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LUCERO LOPEZ-PINTADO
Title or Position: CEO
Credential: PMHNP
Phone: 305-728-9834