Healthcare Provider Details

I. General information

NPI: 1033293402
Provider Name (Legal Business Name): JOSE EMMANUEL RUBIO DE LUNA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 GROSSMONT CENTER DR
LA MESA CA
91942-3074
US

IV. Provider business mailing address

5491 FOXTAIL LOOP
CARLSBAD CA
92010-7150
US

V. Phone/Fax

Practice location:
  • Phone: 619-462-2272
  • Fax:
Mailing address:
  • Phone: 760-931-5973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number47711
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: