MEDICARE: TANIA MIREYA LUNA SA-C

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	246ZC0007X	Surgical Assistant	18-550	FL

General Provider Information

NPI Number	:	1770057796
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANIA MIREYA LUNA SA-C

Provider Business Mailing Address
First Line	:	2135 NW 27TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33142-8453
Country	:	US
Telephone Number	:	786-590-9190
Fax Number	:

Provider Business Practice Location Address
First Line	:	2135 NW 27TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33142-8453
Country	:	US
Telephone Number	:	786-590-9190
Fax Number	:

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

Provider Enumeration Date	:	01/12/2019
Last Update Date	:	01/12/2019

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