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General NPI Number Information
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NPI Number | 1730733254
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Entity Type | Organization
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Legal Business Name | LUMOS PSYCHIATRIC SERVICES LLC
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Dates
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Enumeration Date | 08/01/2019
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Last Update Date | 06/11/2022
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Provider Practice Location Address
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Address Line | 6001 VINELAND RD STE 109
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City | ORLANDO
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State | FL
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Zip | 32819-7829
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Country | US
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Telephone | 407-930-6684
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Fax | 949-404-8433
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Provider Business Mailing Address
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Address Line | 6001 VINELAND RD STE 109
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City | ORLANDO
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State | FL
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Zip | 32819-7829
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Country | US
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Telephone | 407-930-6684
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Fax | 949-404-8433
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Authorized Official
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Title or Position | OWNER
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Name | LUIS J OLIVERA - RODRIGUEZ
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Credential | MD
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Telephone | 407-930-6684
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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