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General NPI Number Information
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NPI Number | 1770436693
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Entity Type | Organization
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Legal Business Name | LUMINI MEDICAL SPA CORP
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Dates
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Enumeration Date | 02/19/2026
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Last Update Date | 02/19/2026
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Provider Practice Location Address
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Address Line | 19565 BISCAYNE BLVD STE 1954
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City | AVENTURA
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State | FL
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Zip | 33180-2392
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Country | US
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Telephone | 305-974-2434
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Fax |
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Provider Business Mailing Address
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Address Line | 587 E SAMPLE RD STE 314
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City | DEERFIELD BEACH
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State | FL
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Zip | 33064-4425
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Country | US
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Telephone | 305-974-2434
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Fax |
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Authorized Official
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Title or Position | OWNER / AGENT
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Name | ANTONIO DIVINO DUTRA FILHO
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Credential |
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Telephone | 305-798-1902
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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