Provider Demographics
NPI:1316331812
Name:LU, RAENA (DC)
Entity type:Individual
Prefix:
First Name:RAENA
Middle Name:
Last Name:LU
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13650 MARINA POINTE DR
Mailing Address - Street 2:UNIT 802
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-9285
Mailing Address - Country:US
Mailing Address - Phone:949-378-3936
Mailing Address - Fax:
Practice Address - Street 1:1535 BAKER ST
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-3731
Practice Address - Country:US
Practice Address - Phone:714-546-1947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-23
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32903111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor