Provider Demographics
NPI:1538782396
Name:FISK, LUKE ALAN
Entity type:Individual
Prefix:
First Name:LUKE
Middle Name:ALAN
Last Name:FISK
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 1:27450 YNEZ RD STE 100
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-4649
Mailing Address - Country:US
Mailing Address - Phone:519-383-4333
Mailing Address - Fax:951-506-2361
Practice Address - Street 1:27450 YNEZ RD STE 100
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-4649
Practice Address - Country:US
Practice Address - Phone:519-383-4333
Practice Address - Fax:951-506-2361
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-27
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95014486363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH37357OtherFAMILY PRACTICE