Healthcare Provider Details

I. General information

NPI: 1396383246
Provider Name (Legal Business Name): LUKES DIETITIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2019
Last Update Date: 01/20/2026
Certification Date: 01/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5030 E 2ND ST STE 200A
LONG BEACH CA
90803-5349
US

IV. Provider business mailing address

5030 E 2ND ST STE 200A
LONG BEACH CA
90803-5349
US

V. Phone/Fax

Practice location:
  • Phone: 909-273-9444
  • Fax:
Mailing address:
  • Phone: 909-273-9444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StateNULL

VIII. Authorized Official

Name: LUKE LUCAS
Title or Position: OWNER
Credential:
Phone: 909-273-9444