Provider Demographics
NPI:1992949804
Name:JUAN F. LUQUE INC.
Entity type:Organization
Organization Name:JUAN F. LUQUE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ OWNER/ DOCTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:FERNANDO
Authorized Official - Last Name:LUQUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD, DDS
Authorized Official - Phone:415-285-0526
Mailing Address - Street 1:2480 MISSION ST
Mailing Address - Street 2:219
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-2468
Mailing Address - Country:US
Mailing Address - Phone:415-285-0526
Mailing Address - Fax:415-285-1906
Practice Address - Street 1:2480 MISSION ST
Practice Address - Street 2:219
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-2468
Practice Address - Country:US
Practice Address - Phone:415-285-0526
Practice Address - Fax:415-285-1906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-22
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48321305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization