Healthcare Provider Details

I. General information

NPI: 1417314931
Provider Name (Legal Business Name): MARILYN LY-LUKE DVM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2016
Last Update Date: 01/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1152 BLOSSOM HILL RD VIP PETCARE
SAN JOSE CA
95118-3127
US

IV. Provider business mailing address

1152 BLOSSOM HILL RD
SAN JOSE CA
95118-3127
US

V. Phone/Fax

Practice location:
  • Phone: 800-427-7973
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number19470
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: