| Lumos Psychiatric Services Llc | |
|
6001 Vineland Rd Ste 109 Orlando FL 32819-7829 | |
| (407) 930-6684 | |
| (949) 404-8433 |
| Full Name | Lumos Psychiatric Services Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 6001 Vineland Rd Ste 109, Orlando, Florida |
| Authorized Official Name and Position | Luis J Olivera - Rodriguez (OWNER) |
| Authorized Official Contact | 4079306684 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lumos Psychiatric Services Llc 6001 Vineland Rd Ste 109 Orlando FL 32819-7829 Ph: (407) 930-6684 | Lumos Psychiatric Services Llc 6001 Vineland Rd Ste 109 Orlando FL 32819-7829 Ph: (407) 930-6684 |
| NPI Number | 1730733254 |
|---|---|
| Provider Enumeration Date | 08/01/2019 |
| Last Update Date | 06/11/2022 |
| Certification Date | 06/11/2022 |
| Medicare PECOS PAC ID | 4183953318 |
|---|---|
| Medicare Enrollment ID | O20190912001538 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730733254 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Luis J Olivera-rodriguez |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1487919932 PECOS PAC ID: 8921393422 Enrollment ID: I20161115000839 |
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