Healthcare Provider Details

I. General information

NPI: 1417494717
Provider Name (Legal Business Name): ANDY LUU FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2017
Last Update Date: 03/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11180 WARNER AVE SUITE 351
FOUNTAIN VALLEY CA
92708-7501
US

IV. Provider business mailing address

11180 WARNER AVE SUITE 351
FOUNTAIN VALLEY CA
92708
US

V. Phone/Fax

Practice location:
  • Phone: 714-698-0300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP95006043
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: