Organization
EAST IVY PANACEA INC
Active
Other names
Lumos Psychiatric Services
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SARBANI MAITRA MD (CEO)
(408) 442-5326
Entity
Organization
Contact information
Practice address
2516 SAMARITAN DR STE B, SAN JOSE, CA 95124-4108
(408) 442-5326
Mailing address
16320 ALEXANDER CT, MONTE SERENO, CA 95030-5204
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Enumeration date
12/02/2020
Last updated
12/02/2020
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