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General NPI Number Information
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NPI Number | 1497955132
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Entity Type | Organization
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Legal Business Name | JESUS LUA, MD, A PROFESSIONAL MEDICAL CORPORATION
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Dates
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Enumeration Date | 07/20/2007
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Last Update Date | 12/05/2011
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Provider Practice Location Address
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Address Line | 360 E 7TH ST SUITE A
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City | UPLAND
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State | CA
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Zip | 91786-6701
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Country | US
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Telephone | 909-985-5784
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Fax | 909-985-7844
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Provider Business Mailing Address
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Address Line | 360 E 7TH ST SUITE A
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City | UPLAND
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State | CA
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Zip | 91786-6701
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Country | US
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Telephone | 909-985-5784
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Fax | 909-985-7844
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | JESUS LUA
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Credential | M.D.
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Telephone | 909-985-5784
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | A50698
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License Number State | CA
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