Healthcare Provider Details

I. General information

NPI: 1699604066
Provider Name (Legal Business Name): LUMINA SURGICAL GYNECOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 S STAPLEY DR STE 120
MESA AZ
85204-6676
US

IV. Provider business mailing address

8722 E LAUREL ST
MESA AZ
85207-3021
US

V. Phone/Fax

Practice location:
  • Phone: 480-744-1518
  • Fax: 602-584-4120
Mailing address:
  • Phone: 602-722-4179
  • Fax: 602-584-4120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMAL MOURAD
Title or Position: OWNER
Credential: DO
Phone: 602-722-4179