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General NPI Number Information
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NPI Number | 1588497580
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Entity Type | Organization
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Legal Business Name | LUMINA MEDICAL GROUP
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Dates
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Enumeration Date | 08/23/2024
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Last Update Date | 08/23/2024
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Provider Practice Location Address
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Address Line | 18001 SKY PARK CIR STE K
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City | IRVINE
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State | CA
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Zip | 92614-0506
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Country | US
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Telephone | 866-665-8646
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Fax |
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Provider Business Mailing Address
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Address Line | 3731 S PLAZA DR
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City | SANTA ANA
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State | CA
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Zip | 92704-7463
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MICAH BRILL
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Credential |
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Telephone | 951-417-2766
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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