Provider Demographics
NPI:1073010740
Name:LUCERNE VALLEY HEALTHCARE, INC.
Entity Type:Organization
Organization Name:LUCERNE VALLEY HEALTHCARE, INC.
Other - Org Name:LUCERNE VALLEY H CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HOANG
Authorized Official - Middle Name:TRAN
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-414-6120
Mailing Address - Street 1:10666 CHAPMAN AVE
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840-3103
Mailing Address - Country:US
Mailing Address - Phone:714-531-7930
Mailing Address - Fax:714-531-7997
Practice Address - Street 1:32770 OLD WOMAN SPRINGS RD
Practice Address - Street 2:UNIT A
Practice Address - City:LUCERNE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92356
Practice Address - Country:US
Practice Address - Phone:714-531-7930
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-10
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty