Healthcare Provider Details

I. General information

NPI: 1528910197
Provider Name (Legal Business Name): LIGHTHOUSE MINDCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2026
Last Update Date: 02/21/2026
Certification Date: 02/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30740 STATE ROAD 54 STE 122
WESLEY CHAPEL FL
33543-6009
US

IV. Provider business mailing address

30740 STATE ROAD 54 STE 145
WESLEY CHAPEL FL
33543-6009
US

V. Phone/Fax

Practice location:
  • Phone: 813-495-2796
  • Fax:
Mailing address:
  • Phone: 813-495-2796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: KARINA MARIE OQUENDO CUEVAS
Title or Position: OWNER
Credential:
Phone: 813-495-2796