Provider Demographics
NPI:1952079956
Name:SWON, LUBA I
Entity Type:Individual
Prefix:
First Name:LUBA
Middle Name:I
Last Name:SWON
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 1:71 MISTY RUN
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-5462
Mailing Address - Country:US
Mailing Address - Phone:949-929-5095
Mailing Address - Fax:
Practice Address - Street 1:71 MISTY RUN
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-5462
Practice Address - Country:US
Practice Address - Phone:949-929-5095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-02
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician