Healthcare Provider Details

I. General information

NPI: 1104249754
Provider Name (Legal Business Name): CHRISTINA LUM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2014
Last Update Date: 01/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 S MAIN ST
WALNUT CREEK CA
94596-5318
US

IV. Provider business mailing address

4135 BUCKINGHAM DR
DANVILLE CA
94506-1282
US

V. Phone/Fax

Practice location:
  • Phone: 925-295-6415
  • Fax:
Mailing address:
  • Phone: 925-736-7912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number29827
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: