Provider Demographics
NPI:1770233447
Name:LUMINOUS PATHWAYS CORPORATION
Entity Type:Organization
Organization Name:LUMINOUS PATHWAYS CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VENKAT
Authorized Official - Middle Name:
Authorized Official - Last Name:GANDHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-640-0797
Mailing Address - Street 1:2809 CARAMOOR LN
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94582-4668
Mailing Address - Country:US
Mailing Address - Phone:925-640-0797
Mailing Address - Fax:
Practice Address - Street 1:2809 CARAMOOR LN
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94582-4668
Practice Address - Country:US
Practice Address - Phone:925-640-0797
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-25
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty