Organization
LUMEN SKIN HEALTH PC
Active
Organization
LUMEN SKIN HEALTH PC
Active
Other names
LUMEN SKINLAB & DERMATOLOGY, LUMEN SKINLAB
Organization subpart
No
Provider details
NPI number
Authorized official
TRACY WIEGAND (CFO & SECRETARY)
(949) 414-8426
Entity
Organization
Contact information
Practice address
250 NEWPORT CENTER DR STE M101, NEWPORT BEACH, CA 92660-7516
(949) 414-8426
Mailing address
250 NEWPORT CENTER DR STE M101, NEWPORT BEACH, CA 92660-7516
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
208200000X
Plastic Surgery Physician
—
—
363A00000X
Physician Assistant
—
—
363AM0700X
Medical Physician Assistant
—
—
Other
Enumeration date
08/08/2025
Last updated
08/04/2026
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