Provider Demographics
NPI:1801284096
Name:LUMBOY, CHARLES DELEON (NP)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:DELEON
Last Name:LUMBOY
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 OAK ST APT 511
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-4606
Mailing Address - Country:US
Mailing Address - Phone:510-387-6708
Mailing Address - Fax:
Practice Address - Street 1:311 OAK ST APT 511
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-4606
Practice Address - Country:US
Practice Address - Phone:510-387-6708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-23
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95001958363LF0000X, 363LF0000X
CANP95001958363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95001958OtherCA BRN FAMILY NURSE PRACTITIONER
CA733932OtherCALIFORNIA RN LICENSE