Provider Demographics
NPI:1316001381
Name:LU, DIVINA GRACIA PANLASIGUI (LVN)
Entity Type:Individual
Prefix:
First Name:DIVINA GRACIA
Middle Name:PANLASIGUI
Last Name:LU
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:PANLASIGUI
Other - Last Name:LU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LVN
Mailing Address - Street 1:3638 HENDRIX DR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95212
Mailing Address - Country:US
Mailing Address - Phone:209-817-5674
Mailing Address - Fax:
Practice Address - Street 1:1839 S EL DORADO ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95206-1305
Practice Address - Country:US
Practice Address - Phone:209-466-4200
Practice Address - Fax:209-466-4446
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN183039164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse