Healthcare Provider Details

I. General information

NPI: 1669582466
Provider Name (Legal Business Name): EMILIO LUNA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 01/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4137 N 108TH AVE
PHOENIX AZ
85037-5459
US

IV. Provider business mailing address

10736 W PEORIA AVE
SUN CITY AZ
85351-4062
US

V. Phone/Fax

Practice location:
  • Phone: 623-877-7337
  • Fax: 623-772-0686
Mailing address:
  • Phone: 623-760-6180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number41114
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: