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General NPI Number Information
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NPI Number | 1063644961
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Entity Type | Organization
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Legal Business Name | ELEANOR M LUMAHAN DDS INC
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Dates
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Enumeration Date | 08/12/2009
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Last Update Date | 10/10/2019
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Provider Practice Location Address
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Address Line | 1127 HIGHLAND AVE
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City | NATIONAL CITY
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State | CA
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Zip | 91950-3517
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Country | US
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Telephone | 619-336-6063
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Fax | 619-336-6066
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Provider Business Mailing Address
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Address Line | 1127 HIGHLAND AVE
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City | NATIONAL CITY
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State | CA
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Zip | 91950-3517
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Country | US
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Telephone | 619-336-6063
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Fax | 619-336-6066
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ELEANOR MADRID LUMAHAN
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Credential | DDS
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Telephone | 619-336-6063
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 54283
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License Number State | CA
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