Healthcare Provider Details

I. General information

NPI: 1023896453
Provider Name (Legal Business Name): MR. LUKAS HALL WARREN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2023
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1036 14TH ST
SAN FRANCISCO CA
94114-1242
US

IV. Provider business mailing address

2649 STRANG BLVD STE 304
YORKTOWN HEIGHTS NY
10598-2938
US

V. Phone/Fax

Practice location:
  • Phone: 910-876-2636
  • Fax:
Mailing address:
  • Phone: 646-745-6369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberCNM08922
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number002361
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: