Healthcare Provider Details

I. General information

NPI: 1417274226
Provider Name (Legal Business Name): MR. JOSE RENE LUCHA JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2010
Last Update Date: 05/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S LAKE AVE STE 205
PASADENA CA
91106-3955
US

IV. Provider business mailing address

38209 43RD ST E
PALMDALE CA
93552-3085
US

V. Phone/Fax

Practice location:
  • Phone: 626-529-1100
  • Fax:
Mailing address:
  • Phone: 661-860-5286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172P00000X
TaxonomyNaprapath
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: