Healthcare Provider Details

I. General information

NPI: 1598554685
Provider Name (Legal Business Name): LUNA CASSANDRA FLYNN ME - PPS SCH. COUN.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2025
Last Update Date: 05/05/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 DANBURY ST
DAVIS CA
95618-4892
US

IV. Provider business mailing address

24680 COUNTY ROAD 101A
DAVIS CA
95616-9409
US

V. Phone/Fax

Practice location:
  • Phone: 530-759-2100
  • Fax:
Mailing address:
  • Phone: 925-322-9378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number230212639
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: