Provider Demographics
NPI:1942921424
Name:LU, JODIE MELINA
Entity Type:Individual
Prefix:MS
First Name:JODIE
Middle Name:MELINA
Last Name:LU
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 1:1693 FLANIGAN DR STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95121-1683
Mailing Address - Country:US
Mailing Address - Phone:408-493-3012
Mailing Address - Fax:
Practice Address - Street 1:1693 FLANIGAN DR STE 100
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95121-1683
Practice Address - Country:US
Practice Address - Phone:408-493-3012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-05
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant