Healthcare Provider Details

I. General information

NPI: 1568372761
Provider Name (Legal Business Name): JESSICA MARIE LUNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8788 ELK GROVE BLVD BLDG 2
ELK GROVE CA
95624-1766
US

IV. Provider business mailing address

PO BOX 1342
LODI CA
95241-1342
US

V. Phone/Fax

Practice location:
  • Phone: 916-956-0436
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number164180
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: