Provider Demographics
NPI:1568265742
Name:LUNA, MARIA ELISHA BARTOLOME
Entity type:Individual
Prefix:
First Name:MARIA ELISHA
Middle Name:BARTOLOME
Last Name:LUNA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2366 MARITIME DR # A
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-3639
Mailing Address - Country:US
Mailing Address - Phone:916-347-4041
Mailing Address - Fax:
Practice Address - Street 1:2366 MARITIME DR # A
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-3639
Practice Address - Country:US
Practice Address - Phone:916-347-4041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician