Provider Demographics
NPI:1568769230
Name:LUZ DEL MUNDO LIGHT OF THE WORLD INC.
Entity Type:Organization
Organization Name:LUZ DEL MUNDO LIGHT OF THE WORLD INC.
Other - Org Name:LIGHT OF THE WORLD CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:R
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:MEDICAL DOCTOR
Authorized Official - Phone:954-563-9876
Mailing Address - Street 1:806 NE 44TH ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33334-3131
Mailing Address - Country:US
Mailing Address - Phone:954-563-9876
Mailing Address - Fax:954-563-3670
Practice Address - Street 1:806 NE 44TH ST
Practice Address - Street 2:
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33334-3131
Practice Address - Country:US
Practice Address - Phone:954-563-9876
Practice Address - Fax:954-563-3670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-16
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health