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Organization
LIGHTHOUSE MEDICAL GROUP OF FLORIDA INC
Active
Organization
LIGHTHOUSE MEDICAL GROUP OF FLORIDA INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAVIER ORTIZ (PRESIDENT)
(305) 606-3543
Entity
Organization
Contact information
Practice address
85 GRAND CANAL DR STE 102, MIAMI, FL 33144-2566
(786) 703-6967
(786) 703-6972
Mailing address
85 GRAND CANAL DR STE 102, MIAMI, FL 33144-2566
(786) 703-6967
(786) 703-6972
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
01/15/2019
Last updated
03/08/2019
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