Basic Information
Provider Information
NPI: 1962148395
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LEMUS HUFSTEDER
FirstName: EMILIANO
MiddleName: LUNA
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 11247
Address2:  
City: BERKELEY
State: CA
PostalCode: 947122247
CountryCode: US
TelephoneNumber: 7142641614
FaxNumber:  
Practice Location
Address1: 150 HARBOUR WAY
Address2:  
City: RICHMOND
State: CA
PostalCode: 948013554
CountryCode: US
TelephoneNumber: 5109814100
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/09/2022
LastUpdateDate: 05/09/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/09/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X  Y Student, Health CareStudent in an Organized Health Care Education/Training Program 

No ID Information.


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