| Light Of Hope Medical Center | |
|
15190 Sw 136th St Ste 26-27 Miami FL 33196-2604 | |
| (786) 404-1008 | |
| (305) 747-7166 |
| Full Name | Light Of Hope Medical Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 15190 Sw 136th St Ste 26-27, Miami, Florida |
| Authorized Official Name and Position | Tania H Perez Gonzalez (CEO) |
| Authorized Official Contact | 7864041008 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Light Of Hope Medical Center 15190 Sw 136th St Ste 26 Miami FL 33196-2618 Ph: (786) 404-1008 | Light Of Hope Medical Center 15190 Sw 136th St Ste 26-27 Miami FL 33196-2604 Ph: (786) 404-1008 |
| NPI Number | 1811628951 |
|---|---|
| Provider Enumeration Date | 06/20/2022 |
| Last Update Date | 06/14/2023 |
| Medicare PECOS PAC ID | 0143603092 |
|---|---|
| Medicare Enrollment ID | O20220927000273 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811628951 | NPI | - | NPPES |
| 115780900 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Eric Miller |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1851557813 PECOS PAC ID: 7618016619 Enrollment ID: I20211112002003 |
| Provider Name | Luis Alain Caceres De Armas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922715978 PECOS PAC ID: 9537532411 Enrollment ID: I20230223000436 |
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