Healthcare Provider Details

I. General information

NPI: 1770363632
Provider Name (Legal Business Name): LUNA NOURI CONTIZANO-MARTINEZ FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LUNA NOURI TOMA

II. Dates (important events)

Enumeration Date: 09/28/2023
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9850 GENESEE AVE STE 320
LA JOLLA CA
92037-1208
US

IV. Provider business mailing address

9850 GENESEE AVE STE 320
LA JOLLA CA
92037-1208
US

V. Phone/Fax

Practice location:
  • Phone: 858-554-1212
  • Fax:
Mailing address:
  • Phone: 858-554-1212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95025389
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95173560
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: