Provider Demographics
NPI:1013012194
Name:LUO, XIAOLU (A P, DOM)
Entity Type:Individual
Prefix:
First Name:XIAOLU
Middle Name:
Last Name:LUO
Suffix:
Gender:M
Credentials:A P, DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10175 FORTUNE PKWY
Mailing Address - Street 2:UNIT 304
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-6749
Mailing Address - Country:US
Mailing Address - Phone:904-880-1889
Mailing Address - Fax:904-880-1889
Practice Address - Street 1:10175 FORTUNE PKWY
Practice Address - Street 2:UNIT 304
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-6749
Practice Address - Country:US
Practice Address - Phone:904-880-1889
Practice Address - Fax:904-880-1889
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM762171100000X
FLAP 1343171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist