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General NPI Number Information
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NPI Number | 1992949804
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Entity Type | Organization
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Legal Business Name | JUAN F. LUQUE INC.
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Dates
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Enumeration Date | 04/22/2009
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Last Update Date | 01/31/2013
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Provider Practice Location Address
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Address Line | 2480 MISSION ST 219
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City | SAN FRANCISCO
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State | CA
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Zip | 94110-2468
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Country | US
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Telephone | 415-285-0526
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Fax | 415-285-1906
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Provider Business Mailing Address
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Address Line | 2480 MISSION ST 219
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City | SAN FRANCISCO
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State | CA
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Zip | 94110-2468
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Country | US
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Telephone | 415-285-0526
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Fax | 415-285-1906
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Authorized Official
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Title or Position | CEO/ OWNER/ DOCTOR
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Name | MR. JUAN FERNANDO LUQUE
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Credential | M.D., D.D.S.
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Telephone | 415-285-0526
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 48321
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License Number State | CA
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