Provider Demographics
NPI:1063209351
Name:KHZOUZ, LUNA (NP)
Entity type:Individual
Prefix:
First Name:LUNA
Middle Name:
Last Name:KHZOUZ
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1847 E BERNIE LN UNIT 106
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-1310
Mailing Address - Country:US
Mailing Address - Phone:947-500-9954
Mailing Address - Fax:
Practice Address - Street 1:1847 E BERNIE LN UNIT 106
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-1310
Practice Address - Country:US
Practice Address - Phone:947-500-9954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ284633363LA2200X
MI4704277562363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health