Provider Demographics
NPI:1356982680
Name:XAVIER, LUKE (NP)
Entity type:Individual
Prefix:
First Name:LUKE
Middle Name:
Last Name:XAVIER
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:LUKE
Other - Middle Name:
Other - Last Name:STORMOGIPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1625 SCHRADER BLVD FL 4
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90028-6213
Mailing Address - Country:US
Mailing Address - Phone:208-699-6129
Mailing Address - Fax:
Practice Address - Street 1:1625 SCHRADER BLVD FL 4
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90028-6213
Practice Address - Country:US
Practice Address - Phone:323-993-7500
Practice Address - Fax:323-308-4456
Is Sole Proprietor?:No
Enumeration Date:2019-10-08
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN-2983363LP0808X
CA951722702084P0800X
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program