| Lumos Advanced Treatment Center Llc | |
|
2516 Samaritan Dr Ste D San Jose CA 95124-4108 | |
| (408) 539-7715 | |
| (408) 402-5116 |
| Full Name | Lumos Advanced Treatment Center Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 2516 Samaritan Dr Ste D, San Jose, California |
| Authorized Official Name and Position | Vidwath Kashyap (BUSINESS DIRECTOR) |
| Authorized Official Contact | 4157416103 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lumos Advanced Treatment Center Llc 2516 Samaritan Dr Ste D San Jose CA 95124-4108 Ph: (415) 741-6103 | Lumos Advanced Treatment Center Llc 2516 Samaritan Dr Ste D San Jose CA 95124-4108 Ph: (408) 539-7715 |
| NPI Number | 1174384846 |
|---|---|
| Provider Enumeration Date | 01/19/2024 |
| Last Update Date | 01/19/2024 |
| Certification Date | 01/19/2024 |
| Medicare PECOS PAC ID | 6103364112 |
|---|---|
| Medicare Enrollment ID | O20240821001270 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174384846 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Sarbani Maitra |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1134360647 PECOS PAC ID: 0244597318 Enrollment ID: I20180720002947 |
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