Provider Demographics
NPI:1083935563
Name:DELA LUNA, LEIF ANTHONY LOPEZ (RPH)
Entity Type:Individual
Prefix:MR
First Name:LEIF ANTHONY
Middle Name:LOPEZ
Last Name:DELA LUNA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:82451 US HIGHWAY 111 STE C
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-5614
Mailing Address - Country:US
Mailing Address - Phone:760-342-7076
Mailing Address - Fax:760-775-7017
Practice Address - Street 1:82451 US HIGHWAY 111 STE C
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-5614
Practice Address - Country:US
Practice Address - Phone:760-342-7076
Practice Address - Fax:760-775-7017
Is Sole Proprietor?:No
Enumeration Date:2010-06-18
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58225183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist