Healthcare Provider Details

I. General information

NPI: 1992119960
Provider Name (Legal Business Name): JOVIE DE LEON-LUCK NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2014
Last Update Date: 06/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7991 SUNKIST DR
OAKLAND CA
94605-3050
US

IV. Provider business mailing address

7991 SUNKIST DR
OAKLAND CA
94605-3050
US

V. Phone/Fax

Practice location:
  • Phone: 510-430-1729
  • Fax:
Mailing address:
  • Phone: 510-430-1729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2100X
TaxonomyAcute Care Clinical Nurse Specialist
License Number3001
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: