Provider Demographics
NPI:1912066804
Name:LUA, ALVARO R
Entity Type:Individual
Prefix:
First Name:ALVARO
Middle Name:R
Last Name:LUA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8611 COLLETT AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91343-5743
Mailing Address - Country:US
Mailing Address - Phone:818-389-8540
Mailing Address - Fax:818-892-5220
Practice Address - Street 1:8611 COLLETT AVE
Practice Address - Street 2:
Practice Address - City:NORTH HILLS
Practice Address - State:CA
Practice Address - Zip Code:91343-5743
Practice Address - Country:US
Practice Address - Phone:818-389-8540
Practice Address - Fax:818-892-5220
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC2848478172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver