Basic Information
| Provider Information | |||||||||
| NPI: | 1811594286 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LUNA | ||||||||
| FirstName: | NATHANAEL | ||||||||
| MiddleName: | JONATHAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4630 BORDER VILLAGE ROAD | ||||||||
| Address2: | SUITE K | ||||||||
| City: | SAN YSIDRO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92173 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6194283760 | ||||||||
| FaxNumber: | 8334691078 | ||||||||
| Practice Location | |||||||||
| Address1: | 4630 BORDER VILLAGE ROAD | ||||||||
| Address2: | SUITE K | ||||||||
| City: | SAN YSIDRO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92173 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6194283760 | ||||||||
| FaxNumber: | 8334691078 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/07/2020 | ||||||||
| LastUpdateDate: | 08/07/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 83337 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Pharmacy Service Providers | Pharmacist |
No ID Information.