MEDICARE: LUMA MEDICAL CLINIC INC

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1336561513
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUMA MEDICAL CLINIC INC

Provider Business Mailing Address
First Line	:	7457 HARWIN DR STE 210
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77036-2024
Country	:	US
Telephone Number	:	832-573-9016
Fax Number	:

Provider Business Practice Location Address
First Line	:	7457 HARWIN DR STE 210
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77036-2024
Country	:	US
Telephone Number	:	832-573-9016
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. DARRYL JOHNSON
Credential	:
Telephone Number	:	832-573-9016

Provider Enumeration Date	:	01/07/2014
Last Update Date	:	01/07/2014

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Directions to “LUMA MEDICAL CLINIC INC ” Practice Location

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