Healthcare Provider Details

I. General information

NPI: 1851084719
Provider Name (Legal Business Name): ELITE MINDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2023
Last Update Date: 04/10/2024
Certification Date: 04/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 E 13TH ST
SAINT CLOUD FL
34769-4749
US

IV. Provider business mailing address

145 E 13TH ST
SAINT CLOUD FL
34769-4749
US

V. Phone/Fax

Practice location:
  • Phone: 407-749-3580
  • Fax:
Mailing address:
  • Phone: 407-749-3580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: WIMAR LOZADA
Title or Position: OWNER
Credential:
Phone: 407-749-3580