Provider Demographics
NPI:1841550332
Name:LUNA, GERMAN
Entity type:Individual
Prefix:
First Name:GERMAN
Middle Name:
Last Name:LUNA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9612 SW 118TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-2714
Mailing Address - Country:US
Mailing Address - Phone:786-267-2417
Mailing Address - Fax:786-267-2417
Practice Address - Street 1:9612 SW 118TH PL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-2714
Practice Address - Country:US
Practice Address - Phone:786-267-2417
Practice Address - Fax:786-267-2417
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-18
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-13-14064103K00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program