MEDICARE: LODY LUMA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1053984203
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LODY LUMA

Provider Business Mailing Address
First Line	:	PO BOX 11181
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77391-1181
Country	:	US
Telephone Number	:	954-982-4197
Fax Number	:	832-202-0525

Provider Business Practice Location Address
First Line	:	1206 NEWSOME GLENN DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77090-7118
Country	:	US
Telephone Number	:	954-982-4197
Fax Number	:	832-202-0525

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/23/2021
Last Update Date	:	07/23/2021

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Directions to “ LODY LUMA ” Practice Location

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