Provider Demographics
NPI:1750849568
Name:LUZ MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:LUZ MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:AIMEE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEYVA LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:786-376-5554
Mailing Address - Street 1:2710 W 60TH PL APT 105
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-5954
Mailing Address - Country:US
Mailing Address - Phone:786-376-5554
Mailing Address - Fax:
Practice Address - Street 1:2387 W 68TH ST STE 303
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-6890
Practice Address - Country:US
Practice Address - Phone:786-376-5554
Practice Address - Fax:786-298-5723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-11
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAPRN11000115OtherLICENSE