MEDICARE: LUMANDA PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center	PA01216	TX
2	261QH0100X	Health Service Clinic/Center	PA01216	TX

General Provider Information

NPI Number	:	1609026475
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUMANDA PA

Provider Business Mailing Address
First Line	:	4010 E BELKNAP ST
Second Line	:
City	:	HALTOM CITY
State	:	TX
Zip	:	76111-6609
Country	:	US
Telephone Number	:	817-834-7161
Fax Number	:	817-834-7104

Provider Business Practice Location Address
First Line	:	4010 E BELKNAP ST
Second Line	:
City	:	HALTOM CITY
State	:	TX
Zip	:	76111-6609
Country	:	US
Telephone Number	:	817-834-7161
Fax Number	:	817-834-7104

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. MICHAEL ANDA NJOTU
Credential	:	PA
Telephone Number	:	817-834-7161

Provider Enumeration Date	:	09/29/2008
Last Update Date	:	09/29/2008

Similar Medicare Providers

1679795900 — MICHAEL ANDA NJOTU PA
Practice Location Address:

4010 E BELKNAP ST
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76111-6609

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1215161005 — LUMANDA, PA
Practice Location Address:

4010 E BELKNAP ST
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76111-6609

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1881663193 — TUAN H NGUYEN MD
Practice Location Address:

4045 E BELKNAP ST , SUITE 12
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Directions to “LUMANDA PA ” Practice Location

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