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General NPI Number Information
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NPI Number | 1124806252
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Entity Type | Organization
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Legal Business Name | LUMINOUS HEALTH INC
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Dates
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Enumeration Date | 09/19/2023
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Last Update Date | 09/19/2023
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Provider Practice Location Address
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Address Line | 1086 S FAIRFAX AVE
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City | LOS ANGELES
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State | CA
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Zip | 90019-4401
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Country | US
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Telephone | 310-818-3476
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Fax | 310-818-3476
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Provider Business Mailing Address
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Address Line | 1086 S FAIRFAX AVE
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City | LOS ANGELES
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State | CA
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Zip | 90019-4401
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Country | US
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Telephone | 310-818-3476
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Fax | 310-818-3476
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Authorized Official
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Title or Position | CEO
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Name | MR. MICHAEL JACOB GHODS
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Credential | MD
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Telephone | 310-430-4513
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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