Provider Demographics
NPI:1851466700
Name:LUNA, JOHN SERAPHIM (OTR)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:SERAPHIM
Last Name:LUNA
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 SOUTH JACKSON
Mailing Address - Street 2:STE 2 & 3
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503
Mailing Address - Country:US
Mailing Address - Phone:956-630-4400
Mailing Address - Fax:956-630-4447
Practice Address - Street 1:1900 SOUTH JACKSON
Practice Address - Street 2:STE 2 & 3
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503
Practice Address - Country:US
Practice Address - Phone:956-630-4400
Practice Address - Fax:956-630-4447
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110825174400000X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX143404501Medicaid
TX143404501Medicaid