Provider Demographics
NPI:1891517983
Name:LUNA, ODESSA BARAYUGA (RN)
Entity type:Individual
Prefix:
First Name:ODESSA
Middle Name:BARAYUGA
Last Name:LUNA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:ODESSA
Other - Middle Name:BARAYUGA
Other - Last Name:GOROSPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2416 E SAINT ANDREW DR
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93730-4761
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1301 M ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93721-1807
Practice Address - Country:US
Practice Address - Phone:559-457-3301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-29
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95044512163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool