Provider Demographics
NPI:1215801386
Name:LUMINA PEDIATRIC CENTER, LLC
Entity type:Organization
Organization Name:LUMINA PEDIATRIC CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEJANDRO
Authorized Official - Middle Name:
Authorized Official - Last Name:HORNIA BOSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-384-0075
Mailing Address - Street 1:8407 PINEHURST DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-1532
Mailing Address - Country:US
Mailing Address - Phone:786-384-0075
Mailing Address - Fax:
Practice Address - Street 1:8407 PINEHURST DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-1532
Practice Address - Country:US
Practice Address - Phone:786-384-0075
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-01
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM3000XAmbulatory Health Care FacilitiesClinic/CenterMedically Fragile Infants and Children Day Care