Provider Demographics
NPI:1225653793
Name:LUCA, MYLINH NAM (MD)
Entity type:Individual
Prefix:
First Name:MYLINH
Middle Name:NAM
Last Name:LUCA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17234 VALLEY BLVD
Mailing Address - Street 2:BLDG A
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335
Mailing Address - Country:US
Mailing Address - Phone:888-576-3348
Mailing Address - Fax:
Practice Address - Street 1:17234 VALLEY BLVD
Practice Address - Street 2:BLDG A
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-2433
Practice Address - Country:US
Practice Address - Phone:888-576-3348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-10
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program