Provider Demographics
NPI:1538306287
Name:DE LUMEN, LUIS SABELINO (DMD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:SABELINO
Last Name:DE LUMEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:823 GATEWAY CENTER WAY
Mailing Address - Street 2:#5
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92102-4541
Mailing Address - Country:US
Mailing Address - Phone:619-906-4623
Mailing Address - Fax:619-906-4564
Practice Address - Street 1:5244 OLIVA AVE
Practice Address - Street 2:#5
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-2352
Practice Address - Country:US
Practice Address - Phone:562-587-1405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-17
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57594122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist