MEDICARE: EVA LU

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	15979	CA

General Provider Information

NPI Number	:	1376961466
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVA LU

Provider Business Mailing Address
First Line	:	3835 3RD AVE APT 8
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-3036
Country	:	US
Telephone Number	:	330-464-6319
Fax Number	:

Provider Business Practice Location Address
First Line	:	3835 3RD AVE APT 8
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-3036
Country	:	US
Telephone Number	:	330-464-6319
Fax Number	:

Authorized Official
Title or Position	:	ACUPUNCTURIST
Name	:	EVA LU
Credential	:	L.AC.
Telephone Number	:	330-464-6319

Provider Enumeration Date	:	04/04/2014
Last Update Date	:	04/04/2014

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