MEDICARE: EBENEZER LUNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183700000X	Pharmacy Technician	72298	CA

General Provider Information

NPI Number	:	1124472725
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EBENEZER LUNA

Provider Business Mailing Address
First Line	:	6748 MISSION ST
Second Line	:
City	:	DALY CITY
State	:	CA
Zip	:	94014-2031
Country	:	US
Telephone Number	:	415-609-0763
Fax Number	:

Provider Business Practice Location Address
First Line	:	6748 MISSION ST
Second Line	:
City	:	DALY CITY
State	:	CA
Zip	:	94014-2031
Country	:	US
Telephone Number	:	415-609-0763
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2016
Last Update Date	:	04/20/2016

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Directions to “ EBENEZER LUNA ” Practice Location

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