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General NPI Number Information
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NPI Number | 1275970378
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Entity Type | Individual
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Provider Name | JOSE IVAN DIAZ-LUNA RPH
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Gender | Male
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Dates
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Enumeration Date | 05/29/2013
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Last Update Date | 05/29/2013
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Provider Practice Location Address
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Address Line | 555 MASSACHUSETTS AVE NW APT.1215
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City | WASHINGTON
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State | DC
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Zip | 20001-4717
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Country | US
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Telephone | 540-449-3115
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Fax |
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Provider Business Mailing Address
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Address Line | 555 MASSACHUSETTS AVE NW APT.1215
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City | WASHINGTON
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State | DC
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Zip | 20001-4717
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Country | US
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Telephone | 540-449-3115
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835P1200X
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Taxonomy Name | Pharmacotherapy Pharmacist
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License Number | PH100001386
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License Number State | DC
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