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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