Healthcare Provider Details

I. General information

NPI: 1093685562
Provider Name (Legal Business Name): BRYAN LUU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2025
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 ARLINGTON AVE
RIVERSIDE CA
92506-3252
US

IV. Provider business mailing address

2755 CANYON SPRINGS PKWY
RIVERSIDE CA
92507-0932
US

V. Phone/Fax

Practice location:
  • Phone: 951-784-6430
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number91643
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: