Provider Demographics
NPI:1316139694
Name:LUQUE, MARIO (CSA-FA)
Entity type:Individual
Prefix:
First Name:MARIO
Middle Name:
Last Name:LUQUE
Suffix:
Gender:M
Credentials:CSA-FA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3078 CLAIRMONT RD NE APT 522
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-1666
Mailing Address - Country:US
Mailing Address - Phone:404-668-6112
Mailing Address - Fax:
Practice Address - Street 1:3078 CLAIRMONT RD NE APT 522
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-1666
Practice Address - Country:US
Practice Address - Phone:404-668-6112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-10
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist