Healthcare Provider Details

I. General information

NPI: 1821770942
Provider Name (Legal Business Name): CARLA C DE LUNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARLA CRYSTAL DE LUNA

II. Dates (important events)

Enumeration Date: 08/07/2023
Last Update Date: 12/19/2023
Certification Date: 12/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 N PLEASANT AVE
FRESNO CA
93728-2434
US

IV. Provider business mailing address

1040 N PLEASANT AVE
FRESNO CA
93728-2434
US

V. Phone/Fax

Practice location:
  • Phone: 559-899-0888
  • Fax:
Mailing address:
  • Phone: 559-899-0888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: