Healthcare Provider Details

I. General information

NPI: 1598305898
Provider Name (Legal Business Name): LUKE M CUA LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2020
Last Update Date: 01/14/2020
Certification Date: 01/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8526 GARVEY AVE
ROSEMEAD CA
91770-2765
US

IV. Provider business mailing address

8526 GARVEY AVE
ROSEMEAD CA
91770-2765
US

V. Phone/Fax

Practice location:
  • Phone: 626-307-9400
  • Fax: 626-307-9445
Mailing address:
  • Phone: 626-307-9400
  • Fax: 626-307-9445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: