Provider Demographics
NPI:1811594286
Name:LUNA, NATHANAEL JONATHAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:NATHANAEL
Middle Name:JONATHAN
Last Name:LUNA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4630 BORDER VILLAGE ROAD
Mailing Address - Street 2:SUITE K
Mailing Address - City:SAN YSIDRO
Mailing Address - State:CA
Mailing Address - Zip Code:92173
Mailing Address - Country:US
Mailing Address - Phone:619-428-3760
Mailing Address - Fax:833-469-1078
Practice Address - Street 1:4630 BORDER VILLAGE ROAD
Practice Address - Street 2:SUITE K
Practice Address - City:SAN YSIDRO
Practice Address - State:CA
Practice Address - Zip Code:92173
Practice Address - Country:US
Practice Address - Phone:619-428-3760
Practice Address - Fax:833-469-1078
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-07
Last Update Date:2022-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83337183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty