Provider Demographics
NPI:1033228028
Name:AHUMADA-ALBA, LUCY (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:LUCY
Middle Name:
Last Name:AHUMADA-ALBA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 HARKNESS LN
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-4156
Mailing Address - Country:US
Mailing Address - Phone:310-318-2032
Mailing Address - Fax:
Practice Address - Street 1:3400 E FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-5835
Practice Address - Country:US
Practice Address - Phone:323-589-9384
Practice Address - Fax:323-589-0358
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA13539207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA13539Medicaid