Provider Demographics
NPI:1649360991
Name:LUA, CAESAR
Entity type:Individual
Prefix:MR
First Name:CAESAR
Middle Name:
Last Name:LUA
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 1:1836 E COLORADO BLVD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-3544
Mailing Address - Country:US
Mailing Address - Phone:626-796-4971
Mailing Address - Fax:626-796-9128
Practice Address - Street 1:1836 E COLORADO BLVD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-3544
Practice Address - Country:US
Practice Address - Phone:626-796-4971
Practice Address - Fax:626-796-9128
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-14
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6391520001Medicare NSC
CA1275980001Medicare ID - Type UnspecifiedMEDICARE PROVIDER #