Healthcare Provider Details

I. General information

NPI: 1447763206
Provider Name (Legal Business Name): IRENE LUY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2017
Last Update Date: 11/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

543 SWEETWATER RD
SPRING VALLEY CA
91977-5627
US

IV. Provider business mailing address

2535 FENTON PKWY APT 309
SAN DIEGO CA
92108-6767
US

V. Phone/Fax

Practice location:
  • Phone: 619-461-2100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number77349
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: