Provider Demographics
NPI:1487076469
Name:LIGHT & WELLNESS CENTER INC
Entity type:Organization
Organization Name:LIGHT & WELLNESS CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ MAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-393-0457
Mailing Address - Street 1:2711 SW 137TH AVE
Mailing Address - Street 2:STE 85
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-6359
Mailing Address - Country:US
Mailing Address - Phone:786-393-0457
Mailing Address - Fax:305-551-1121
Practice Address - Street 1:2711 SW 137TH AVE
Practice Address - Street 2:STE 85
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-6359
Practice Address - Country:US
Practice Address - Phone:786-393-0457
Practice Address - Fax:305-551-1121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-10
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME91436261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service