Provider Demographics
NPI:1407493166
Name:LUMINARY HEALTHCARE, INC.
Entity Type:Organization
Organization Name:LUMINARY HEALTHCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MANEESH
Authorized Official - Middle Name:ASHLEY
Authorized Official - Last Name:BANSAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:424-349-7108
Mailing Address - Street 1:721 N EUCLID ST STE 100
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-4116
Mailing Address - Country:US
Mailing Address - Phone:424-349-7108
Mailing Address - Fax:
Practice Address - Street 1:721 N EUCLID ST STE 100
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-4116
Practice Address - Country:US
Practice Address - Phone:424-349-7108
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-02
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty