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General NPI Number Information
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NPI Number | 1134515455
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Entity Type | Organization
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Legal Business Name | LUMINANCE RECOVERY CENTER
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Dates
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Enumeration Date | 04/14/2015
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Last Update Date | 05/09/2016
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Provider Practice Location Address
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Address Line | 27126B PASEO ESPADA # B SUITE 721
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675-2721
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Country | US
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Telephone | 949-359-7300
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Fax |
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Provider Business Mailing Address
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Address Line | 27131 CALLE ARROYO STE 1703
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675-2700
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Country | US
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Telephone | 949-359-7300
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Fax |
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Authorized Official
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Title or Position | MANAGING DIRECTOR
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Name | MICHAEL CASTANON
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Credential |
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Telephone | 949-359-7326
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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