Provider Demographics
NPI:1952856502
Name:LU, WEIYA DOUGLAS (PHD,NP,MSN,RN)
Entity Type:Individual
Prefix:
First Name:WEIYA
Middle Name:DOUGLAS
Last Name:LU
Suffix:
Gender:M
Credentials:PHD,NP,MSN,RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18144 SECO ST
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:CA
Mailing Address - Zip Code:95327-9498
Mailing Address - Country:US
Mailing Address - Phone:209-984-4820
Mailing Address - Fax:209-984-4825
Practice Address - Street 1:18144 SECO ST
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:CA
Practice Address - Zip Code:95327-9498
Practice Address - Country:US
Practice Address - Phone:209-984-4820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95070370163W00000X
CA95007305363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95007305OtherNP-FURNISHING
ML4564060OtherDEA
CA95007305OtherNP-FURNISHING