Provider Demographics
NPI:1154100865
Name:LUNA RODRIGUEZ, ARACELI
Entity type:Individual
Prefix:
First Name:ARACELI
Middle Name:
Last Name:LUNA RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2417 PRESIDIO VISTA DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76177-8277
Mailing Address - Country:US
Mailing Address - Phone:682-316-9008
Mailing Address - Fax:
Practice Address - Street 1:2417 PRESIDIO VISTA DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76177-8277
Practice Address - Country:US
Practice Address - Phone:682-316-9008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-22
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst