Provider Demographics
NPI:1861678591
Name:TUMIALAN, LUIS MANUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:MANUEL
Last Name:TUMIALAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2910 N 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-4434
Mailing Address - Country:US
Mailing Address - Phone:480-425-8004
Mailing Address - Fax:480-425-8002
Practice Address - Street 1:7242 E OSBORN RD #420
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251
Practice Address - Country:US
Practice Address - Phone:480-425-8004
Practice Address - Fax:602-294-8264
Is Sole Proprietor?:No
Enumeration Date:2008-01-11
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA104783207T00000X
AZ42899207T00000X
GA052845207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ515601Medicaid
AZ515601Medicaid