MEDICARE: DR. EMMANUEL CORREA LUNA M.D.

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	207Q00000X	Family Medicine Physician	A49643	CA

General Provider Information

NPI Number	:	1316968571
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EMMANUEL CORREA LUNA M.D.

Provider Business Mailing Address
First Line	:	1500 S CENTRAL AVE
Second Line	:	SUITE 321
City	:	GLENDALE
State	:	CA
Zip	:	91204-2530
Country	:	US
Telephone Number	:	818-500-0880
Fax Number	:	818-500-0221

Provider Business Practice Location Address
First Line	:	1500 S CENTRAL AVE
Second Line	:	SUITE 321
City	:	GLENDALE
State	:	CA
Zip	:	91204-2530
Country	:	US
Telephone Number	:	818-500-0880
Fax Number	:	818-500-0221

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

Provider Enumeration Date	:	07/22/2006
Last Update Date	:	02/19/2008

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