Provider Demographics
NPI:1275970378
Name:DIAZ-LUNA, JOSE IVAN (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:IVAN
Last Name:DIAZ-LUNA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 MASSACHUSETTS AVE NW
Mailing Address - Street 2:APT.1215
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-4717
Mailing Address - Country:US
Mailing Address - Phone:540-449-3115
Mailing Address - Fax:
Practice Address - Street 1:555 MASSACHUSETTS AVE NW
Practice Address - Street 2:APT.1215
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-4717
Practice Address - Country:US
Practice Address - Phone:540-449-3115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-29
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPH1000013861835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy