Provider Demographics
NPI:1407577737
Name:LUU, OPHELIA (PA)
Entity type:Individual
Prefix:
First Name:OPHELIA
Middle Name:
Last Name:LUU
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3220 N 38TH ST UNIT 38
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-6318
Mailing Address - Country:US
Mailing Address - Phone:574-549-2776
Mailing Address - Fax:
Practice Address - Street 1:1008 E MCDOWELL RD STE A
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2603
Practice Address - Country:US
Practice Address - Phone:602-358-8858
Practice Address - Fax:602-688-6991
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-06
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN10003773A363A00000X
AZ10571363A00000X
IN1191147363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant