Healthcare Provider Details

I. General information

NPI: 1114550175
Provider Name (Legal Business Name): LUMINOUS PATHOLOGY ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2020
Last Update Date: 02/20/2020
Certification Date: 02/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5909 WEST LOOP S STE 310
BELLAIRE TX
77401-2402
US

IV. Provider business mailing address

5830 E 2ND ST STE 7000
CASPER WY
82609-4308
US

V. Phone/Fax

Practice location:
  • Phone: 713-542-8592
  • Fax:
Mailing address:
  • Phone: 713-542-8592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0104X
TaxonomyChemical Pathology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207ZI0100X
TaxonomyImmunopathology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207ZM0300X
TaxonomyMedical Microbiology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207ZC0008X
TaxonomyClinical Informatics (Pathology) Physician
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code207ZP0007X
TaxonomyMolecular Genetic Pathology (Pathology) Physician
License Number
License Number State

VIII. Authorized Official

Name: KEVIN PAUL ROSENBLATT
Title or Position: PHYSICIAN MEMBER
Credential: MD, PHD
Phone: 713-542-8592