Healthcare Provider Details

I. General information

NPI: 1457457756
Provider Name (Legal Business Name): NATHAN LUNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 01/04/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4460 E HUNTINGTON AVE
FRESNO CA
93702-2962
US

IV. Provider business mailing address

1465 65TH ST # 201
EMERYVILLE CA
94608-1062
US

V. Phone/Fax

Practice location:
  • Phone: 559-459-4300
  • Fax: 559-459-4569
Mailing address:
  • Phone: 510-594-1816
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA82622
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberA82622
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: