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NPI Code Detail

MEDICARE: LUCY EDEH LVN

MEDICARE: LUCY EDEH LVN
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
1164X00000XLicensed Vocational Nurse292903CA

General Provider Information

NPI Number : 1639822034
Entity Type Code : Individual
Provider Name (Legal Business Name) : LUCY EDEH LVN
Provider Business Mailing Address
First Line : 18949 REDWOOD RD
Second Line :
City : CASTRO VALLEY
State : CA
Zip : 94546-3153
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 18949 REDWOOD RD
Second Line :
City : CASTRO VALLEY
State : CA
Zip : 94546-3153
Country : US
Telephone Number : 510-881-1606
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/27/2022
Last Update Date : 01/27/2022

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