Provider Demographics
NPI:1962615369
Name:LUNA, JAIME RAUL (PA-C)
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:RAUL
Last Name:LUNA
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:10789 SLATER AVE
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-3931
Mailing Address - Country:US
Mailing Address - Phone:714-964-0533
Mailing Address - Fax:
Practice Address - Street 1:2650 S BRISTOL ST
Practice Address - Street 2:SUITE 101
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-5751
Practice Address - Country:US
Practice Address - Phone:714-754-1444
Practice Address - Fax:714-754-7009
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2011-12-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA14347363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant