Provider Demographics
NPI:1962415141
Name:LUNA, LELANIE MEDINA (MD)
Entity type:Individual
Prefix:DR
First Name:LELANIE
Middle Name:MEDINA
Last Name:LUNA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1500 S CENTRAL AVE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-2530
Mailing Address - Country:US
Mailing Address - Phone:818-500-1331
Mailing Address - Fax:818-500-1595
Practice Address - Street 1:1500 S CENTRAL AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-2530
Practice Address - Country:US
Practice Address - Phone:818-500-1331
Practice Address - Fax:818-500-1595
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2008-01-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA499592080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine