NPIMap

Organization Active NPI

Lighthouse Pediatrics PLLC

  • Pediatrics Physician
  • St Augustine, FL
National Provider Identifier
1043630353
Registry record updated Apr 25, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
ME90727 Issued in FL
Legal business name
LIGHTHOUSE PEDIATRICS PLLC
Practice address
100 Whetstone PL
Suite 211
St Augustine, FL 32086-5774
Phone
(904) 342-7648
Fax
(904) 342-8567
NPI assigned
Apr 25, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Vincent Luz, MDNPI 1477658342
Title
Owner
Phone
(904) 342-7648

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X ME90727 FL Primary

Addresses

Primary practice location

100 Whetstone PL
Suite 211
St Augustine, FL 32086-5774

Mailing address

100 Whetstone PL
Suite 211
St Augustine, FL 32086-5774
Phone (904) 342-7648

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1398384000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1398384000000",
    "number": "1043630353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 WHETSTONE PL",
            "address_2": "SUITE 211",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320865774",
            "telephone_number": "904-342-7648",
            "fax_number": "904-342-8567"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 WHETSTONE PL",
            "address_2": "SUITE 211",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320865774",
            "telephone_number": "904-342-7648",
            "fax_number": "904-342-8567"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIGHTHOUSE PEDIATRICS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-25",
        "last_updated": "2014-04-25",
        "status": "A",
        "authorized_official_last_name": "LUZ",
        "authorized_official_first_name": "VINCENT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "904-342-7648",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME90727",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Augustine, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.