Healthcare Provider Details

I. General information

NPI: 1184133191
Provider Name (Legal Business Name): LUMIN ENTERPRISES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2017
Last Update Date: 09/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15207 N 75TH ST STE 111
SCOTTSDALE AZ
85260-2445
US

IV. Provider business mailing address

15207 N 75TH ST STE 111
SCOTTSDALE AZ
85260-2445
US

V. Phone/Fax

Practice location:
  • Phone: 877-254-7838
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: SARA LOGUERCIO
Title or Position: VP
Credential:
Phone: 714-316-6082