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General NPI Number Information
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NPI Number | 1952269938
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Entity Type | Organization
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Legal Business Name | LUMIVARA HEALTH LLC
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Dates
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Enumeration Date | 01/09/2026
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Last Update Date | 01/09/2026
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Provider Practice Location Address
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Address Line | 9920 BOE RD
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City | IRVINGTON
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State | AL
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Zip | 36544-2766
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Country | US
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Telephone | 334-780-8814
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Fax |
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Provider Business Mailing Address
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Address Line | 9920 BOE RD
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City | IRVINGTON
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State | AL
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Zip | 36544-2766
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Country | US
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Telephone | 334-780-8814
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. VIENGXAY THOMAS MALAVONG
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Credential | D.O.
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Telephone | 334-780-8814
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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