Healthcare Provider Details

I. General information

NPI: 1952856502
Provider Name (Legal Business Name): WEIYA DOUGLAS LU PH.D.,NP,MSN,RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2016
Last Update Date: 10/15/2024
Certification Date: 04/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3280 E FOOTHILL BLVD
PASADENA CA
91107-3148
US

IV. Provider business mailing address

18144 SECO ST
JAMESTOWN CA
95327-9498
US

V. Phone/Fax

Practice location:
  • Phone: 833-574-2273
  • Fax:
Mailing address:
  • Phone: 209-984-4820
  • Fax: 209-984-4825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95007305
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95070370
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: