Healthcare Provider Details

I. General information

NPI: 1083499701
Provider Name (Legal Business Name): QUANG LU CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2023
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1648 E BERETTA PL
CHANDLER AZ
85286-1153
US

IV. Provider business mailing address

1648 E BERETTA PL
CHANDLER AZ
85286-1153
US

V. Phone/Fax

Practice location:
  • Phone: 678-510-3849
  • Fax:
Mailing address:
  • Phone: 678-510-3849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number308880
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number308880
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number95418374
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: