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General NPI Number Information
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NPI Number | 1215748934
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Entity Type | Organization
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Legal Business Name | LUMINA WELLNESS GROUP LLC
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Dates
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Enumeration Date | 01/14/2025
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Last Update Date | 01/12/2026
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Provider Practice Location Address
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Address Line | 737 NORTH WEST 135TH AVENUE
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City | PEMBROKE PINES
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State | FL
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Zip | 33028
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Country | US
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Telephone | 786-200-7553
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Fax |
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Provider Business Mailing Address
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Address Line | 2114 N FLAMINGO RD # 5034
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City | PEMBROKE PINES
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State | FL
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Zip | 33028-3501
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Country | US
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Telephone | 786-200-7553
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ALEXANDER STEPHENS
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Credential | FNP
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Telephone | 786-200-7553
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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