Provider Demographics
NPI:1033293402
Name:DE LUNA, JOSE EMMANUEL RUBIO (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSE EMMANUEL
Middle Name:RUBIO
Last Name:DE LUNA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5491 FOXTAIL LOOP
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92010-7150
Mailing Address - Country:US
Mailing Address - Phone:760-931-5973
Mailing Address - Fax:
Practice Address - Street 1:5601 GROSSMONT CENTER DR
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3074
Practice Address - Country:US
Practice Address - Phone:619-462-2272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA477111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice