Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 64209 | CA |
NPI | 1003343765 |
---|---|
Provider Name | Antonio Luna-Salguero |
First Address | Irvine, CA 92618-1584 |
Second Address | Irvine, CA 92618-1584 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2017 |
Last Update Date | 12/05/2017 |