Healthcare Provider Details

I. General information

NPI: 1134185333
Provider Name (Legal Business Name): MR. LU SAELEE
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 HARRIS AVENUE SUITE A
SACRAMENTO CA
95838
US

IV. Provider business mailing address

310 HARRIS AVENUE SUITE A
SACRAMENTO CA
95838
US

V. Phone/Fax

Practice location:
  • Phone: 916-649-6793
  • Fax: 916-929-7411
Mailing address:
  • Phone: 916-649-6793
  • Fax: 916-929-7411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberRAS S0411260914
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: