Provider Demographics
NPI:1700309689
Name:LUMINA FAMILY CARE, INC.
Entity Type:Organization
Organization Name:LUMINA FAMILY CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ELIAS
Authorized Official - Middle Name:F
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-682-1622
Mailing Address - Street 1:6780 INDIANA AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-4284
Mailing Address - Country:US
Mailing Address - Phone:951-682-1622
Mailing Address - Fax:951-682-5902
Practice Address - Street 1:6780 INDIANA AVE STE 110
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-4284
Practice Address - Country:US
Practice Address - Phone:951-682-1622
Practice Address - Fax:951-682-5902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA67841207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty