MEDICARE: NATALIA LUQUE D.D.S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	59110	CA

General Provider Information

NPI Number	:	1952632309
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATALIA LUQUE D.D.S

Provider Business Mailing Address
First Line	:	820 DOLORES ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94110-2207
Country	:	US
Telephone Number	:	415-946-9676
Fax Number	:	415-285-1926

Provider Business Practice Location Address
First Line	:	2725 MISSION ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94110-3103
Country	:	US
Telephone Number	:	415-824-2292
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2010
Last Update Date	:	01/25/2010

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