Provider Demographics
NPI:1417726795
Name:LUMUS
Entity Type:Organization
Organization Name:LUMUS
Other - Org Name:LUMUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-394-3330
Mailing Address - Street 1:284 DUPONT ST STE 130
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-6029
Mailing Address - Country:US
Mailing Address - Phone:951-394-3330
Mailing Address - Fax:
Practice Address - Street 1:284 DUPONT ST STE 130
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-6029
Practice Address - Country:US
Practice Address - Phone:951-394-3330
Practice Address - Fax:818-338-0470
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MICHAEL GARCIA, M.D., INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-12-27
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)