Provider Demographics
NPI:1154431484
Name:UY, CARMELITA LUNA (MD)
Entity type:Individual
Prefix:MRS
First Name:CARMELITA
Middle Name:LUNA
Last Name:UY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1040 TIERRA DEL REY
Mailing Address - Street 2:SUITE 107
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910
Mailing Address - Country:US
Mailing Address - Phone:619-216-8500
Mailing Address - Fax:619-216-8511
Practice Address - Street 1:1040 TIERRA DEL REY
Practice Address - Street 2:SUITE 107
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-7865
Practice Address - Country:US
Practice Address - Phone:619-216-8500
Practice Address - Fax:619-216-8511
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC50548173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C505480Medicaid
CA00C505480Medicaid