Provider Demographics
NPI:1730733254
Name:LUMOS PSYCHIATRIC SERVICES LLC
Entity type:Organization
Organization Name:LUMOS PSYCHIATRIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:OLIVERA - RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-930-6684
Mailing Address - Street 1:6001 VINELAND RD STE 109
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-7829
Mailing Address - Country:US
Mailing Address - Phone:407-930-6684
Mailing Address - Fax:949-404-8433
Practice Address - Street 1:6001 VINELAND RD STE 109
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-7829
Practice Address - Country:US
Practice Address - Phone:407-930-6684
Practice Address - Fax:949-404-8433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-01
Last Update Date:2022-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty