MEDICARE: DR. ELEANOR MADRID LUMAHAN DDS

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	1223G0001X	General Practice Dentistry	54283	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	D54283	OTHER	CA	DENTICAL

General Provider Information

NPI Number	:	1518105089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELEANOR MADRID LUMAHAN DDS

Provider Business Mailing Address
First Line	:	1127 HIGHLAND AVE
Second Line	:
City	:	NATIONAL CITY
State	:	CA
Zip	:	91950-3517
Country	:	US
Telephone Number	:	619-336-6063
Fax Number	:	619-336-6066

Provider Business Practice Location Address
First Line	:	1127 HIGHLAND AVE
Second Line	:
City	:	NATIONAL CITY
State	:	CA
Zip	:	91950-3517
Country	:	US
Telephone Number	:	619-336-6063
Fax Number	:	619-336-6066

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

Provider Enumeration Date	:	01/21/2009
Last Update Date	:	06/30/2009

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