Provider Demographics
NPI:1215431085
Name:LUNA, BRYAN RENE (RDN)
Entity type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:RENE
Last Name:LUNA
Suffix:
Gender:M
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39068 SUNDANCE CIR
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-7425
Mailing Address - Country:US
Mailing Address - Phone:360-904-1732
Mailing Address - Fax:
Practice Address - Street 1:39068 SUNDANCE CIR
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-7425
Practice Address - Country:US
Practice Address - Phone:360-904-1732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-19
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA716841133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered