Healthcare Provider Details

I. General information

NPI: 1881168623
Provider Name (Legal Business Name): DONNA E LUEDER RRT, RCP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2019
Last Update Date: 01/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 LAWRENCE EXPY DEPT 282
SANTA CLARA CA
95051-5173
US

IV. Provider business mailing address

710 LAWRENCE EXPY DEPT 282
SANTA CLARA CA
95051-5173
US

V. Phone/Fax

Practice location:
  • Phone: 408-851-9028
  • Fax: 408-851-2599
Mailing address:
  • Phone: 408-851-9028
  • Fax: 408-851-2599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279C0205X
TaxonomyCritical Care Registered Respiratory Therapist
License Number1175
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: