Healthcare Provider Details

I. General information

NPI: 1902779192
Provider Name (Legal Business Name): TRISHA LU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2025
Last Update Date: 12/20/2025
Certification Date: 12/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2521 EASTBLUFF DR
NEWPORT BEACH CA
92660-3504
US

IV. Provider business mailing address

2521 EASTBLUFF DR
NEWPORT BEACH CA
92660-3504
US

V. Phone/Fax

Practice location:
  • Phone: 949-717-6642
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number91319
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: