Provider Demographics
NPI:1750037982
Name:LOTUS WELLNESS INSTITUTE, LLC
Entity Type:Organization
Organization Name:LOTUS WELLNESS INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MAIRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAMIZO RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:786-457-0375
Mailing Address - Street 1:10651 N KENDALL DR STE 100
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-1573
Mailing Address - Country:US
Mailing Address - Phone:786-502-2454
Mailing Address - Fax:786-502-2454
Practice Address - Street 1:10651 N KENDALL DR STE 100
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-1573
Practice Address - Country:US
Practice Address - Phone:786-502-2454
Practice Address - Fax:786-502-2454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-25
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty