Healthcare Provider Details

I. General information

NPI: 1073421871
Provider Name (Legal Business Name): DANIELA VIANEY LUQUIN I
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3081 TEAGARDEN ST
SAN LEANDRO CA
94577-5720
US

IV. Provider business mailing address

21059 ROYAL AVE APT 4
HAYWARD ACRES CA
94541-4763
US

V. Phone/Fax

Practice location:
  • Phone: 510-347-4620
  • Fax:
Mailing address:
  • Phone: 510-265-9562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: