Provider Demographics
NPI:1295470151
Name:MB LUM LLC
Entity Type:Organization
Organization Name:MB LUM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:BOLANO
Authorized Official - Last Name:LUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-524-6700
Mailing Address - Street 1:712 EL CERRITO PLZ
Mailing Address - Street 2:
Mailing Address - City:EL CERRITO
Mailing Address - State:CA
Mailing Address - Zip Code:94530-4021
Mailing Address - Country:US
Mailing Address - Phone:510-524-6700
Mailing Address - Fax:510-524-4092
Practice Address - Street 1:712 EL CERRITO PLZ
Practice Address - Street 2:
Practice Address - City:EL CERRITO
Practice Address - State:CA
Practice Address - Zip Code:94530-4021
Practice Address - Country:US
Practice Address - Phone:510-524-6700
Practice Address - Fax:510-524-4092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-04
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health