Provider Demographics
NPI:1588139083
Name:KOLAK, LUCA ANDREA
Entity type:Individual
Prefix:
First Name:LUCA
Middle Name:ANDREA
Last Name:KOLAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SUSY
Other - Middle Name:J
Other - Last Name:KOLAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3671 BUSINESS DR STE 110
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95820-2233
Mailing Address - Country:US
Mailing Address - Phone:916-734-8396
Mailing Address - Fax:916-454-1240
Practice Address - Street 1:3671 BUSINESS DR STE 110
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95820-2233
Practice Address - Country:US
Practice Address - Phone:916-734-8396
Practice Address - Fax:916-454-1240
Is Sole Proprietor?:No
Enumeration Date:2018-10-10
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program