Provider Demographics
NPI:1386888394
Name:DR. MONICA R. LUNA, LLC
Entity type:Organization
Organization Name:DR. MONICA R. LUNA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:LUNA
Authorized Official - Suffix:
Authorized Official - Credentials:DOM
Authorized Official - Phone:505-231-6236
Mailing Address - Street 1:2323 CALLE LUMINOSO
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-5609
Mailing Address - Country:US
Mailing Address - Phone:505-231-6236
Mailing Address - Fax:505-424-1426
Practice Address - Street 1:1622 GALISTEO ST
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4747
Practice Address - Country:US
Practice Address - Phone:505-231-6236
Practice Address - Fax:505-424-1426
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR. MONICA R. LUNA, DOM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-04-22
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM963171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1508013855OtherNPI TYPE I