Provider Demographics
NPI:1811777980
Name:LUNA, ALEXIS BRIANNA
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:BRIANNA
Last Name:LUNA
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 1:1601 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73106-4434
Mailing Address - Country:US
Mailing Address - Phone:810-877-0113
Mailing Address - Fax:
Practice Address - Street 1:1400 SE 4TH ST STE B
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-7328
Practice Address - Country:US
Practice Address - Phone:405-338-7674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-04
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator