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General NPI Number Information
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NPI Number | 1518371384
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Entity Type | Individual
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Provider Name | MICKEY LUI D.O.
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Gender | Male
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Dates
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Enumeration Date | 06/19/2014
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Last Update Date | 12/24/2019
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Provider Practice Location Address
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Address Line | 25333 BARTON RD
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City | LOMA LINDA
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State | CA
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Zip | 92350-0210
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Country | US
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Telephone | 510-859-7640
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Fax |
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Provider Business Mailing Address
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Address Line | 1142 S DIAMOND BAR BLVD STE 784
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City | DIAMOND BAR
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State | CA
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Zip | 91765-2203
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Country | US
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Telephone | 510-859-7640
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Fax | 888-939-4225
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 20A14387
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License Number State | CA
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