Basic Information
| Provider Information | |||||||||
| NPI: | 1447899976 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LU | ||||||||
| FirstName: | CYNTHIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16818 E BROOKPORT ST | ||||||||
| Address2: | |||||||||
| City: | COVINA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917222426 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6618771001 | ||||||||
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| Practice Location | |||||||||
| Address1: | 525 N GARFIELD AVE | ||||||||
| Address2: | |||||||||
| City: | MONTEREY PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917541202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6265732222 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/01/2020 | ||||||||
| LastUpdateDate: | 01/01/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 95013474 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.