1750165858 NPI number — ANTHONY HUY LUU BA PSYCHOLOGY

Table of content: ANTHONY HUY LUU BA PSYCHOLOGY (NPI 1750165858)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750165858 NPI number — ANTHONY HUY LUU BA PSYCHOLOGY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUU
Provider First Name:
ANTHONY
Provider Middle Name:
HUY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BA PSYCHOLOGY
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
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Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750165858
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/21/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1200 CONCORD AVE STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CONCORD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94520-4969
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 CONCORD AVE STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CONCORD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94520-4969
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-268-8120
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/21/2023

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
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Provider Taxonomy Codes

  • Taxonomy code: 106S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)