Provider Demographics
NPI:1659036721
Name:LUKBAN, LADYLEEN
Entity Type:Individual
Prefix:
First Name:LADYLEEN
Middle Name:
Last Name:LUKBAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31770 ALVARADO BLVD APT 55
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94587-3961
Mailing Address - Country:US
Mailing Address - Phone:510-697-8455
Mailing Address - Fax:
Practice Address - Street 1:31770 ALVARADO BLVD APT 55
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:CA
Practice Address - Zip Code:94587-3961
Practice Address - Country:US
Practice Address - Phone:510-697-8455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95241733163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse