Healthcare Provider Details

I. General information

NPI: 1124712872
Provider Name (Legal Business Name): VALERIE GISELLE LUA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2023
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E MAIN ST STE 130
ALHAMBRA CA
91801-3580
US

IV. Provider business mailing address

1428 LYNDON ST APT 4
SOUTH PASADENA CA
91030-3867
US

V. Phone/Fax

Practice location:
  • Phone: 209-201-7928
  • Fax:
Mailing address:
  • Phone: 209-201-7928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDDS113526
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: