Healthcare Provider Details

I. General information

NPI: 1255263885
Provider Name (Legal Business Name): LUMINA CLINICAL LAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

458 BOYNTON AVE APT A2
SAN JOSE CA
95117-1426
US

IV. Provider business mailing address

458 BOYNTON AVE APT A2
SAN JOSE CA
95117-1426
US

V. Phone/Fax

Practice location:
  • Phone: 409-995-2239
  • Fax:
Mailing address:
  • Phone: 409-995-2239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: NO NAME GIVEN SACHIN
Title or Position: PRESIDENT
Credential:
Phone: 409-995-2239