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NPI Code Detail

MEDICARE: MANUEL LUA MFT

MEDICARE: MANUEL LUA MFT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family Therapist771119CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1106H00000XOTHERCATAXONOMY

General Provider Information

NPI Number : 1780779504
Entity Type Code : Individual
Provider Name (Legal Business Name) : MANUEL LUA MFT
Provider Business Mailing Address
First Line : 2495 W MARCH LN
Second Line :
City : STOCKTON
State : CA
Zip : 95207-8251
Country : US
Telephone Number : 209-320-7600
Fax Number :
Provider Business Practice Location Address
First Line : 2495 W MARCH LN STE 125
Second Line :
City : STOCKTON
State : CA
Zip : 95207-8224
Country : US
Telephone Number : 209-320-7615
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2006
Last Update Date : 07/26/2016

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Directions to “ MANUEL LUA MFT” Practice Location

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