Provider Demographics
NPI:1144794579
Name:LU, VICTORIA (ATC)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:LU
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20318 JULLIARD DR
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-2433
Mailing Address - Country:US
Mailing Address - Phone:909-569-9629
Mailing Address - Fax:
Practice Address - Street 1:15325 LOS ROBLES AVE
Practice Address - Street 2:
Practice Address - City:HACIENDA HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91745-2717
Practice Address - Country:US
Practice Address - Phone:909-569-9629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-18
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer