Provider Demographics
NPI:1124406954
Name:LOTUS HEALTH & THERAPY CENTER LLC
Entity Type:Organization
Organization Name:LOTUS HEALTH & THERAPY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUISA
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-615-8805
Mailing Address - Street 1:717 PONCE DE LEON BLVD
Mailing Address - Street 2:STE 219
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-2060
Mailing Address - Country:US
Mailing Address - Phone:786-615-8805
Mailing Address - Fax:786-487-6716
Practice Address - Street 1:717 PONCE DE LEON BLVD
Practice Address - Street 2:STE 219
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-2060
Practice Address - Country:US
Practice Address - Phone:786-615-8805
Practice Address - Fax:786-487-6716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-13
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service