Healthcare Provider Details

I. General information

NPI: 1740997667
Provider Name (Legal Business Name): JOSE LUNA MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2022
Last Update Date: 10/31/2022
Certification Date: 10/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2051 N BEVERLY PLZ APT 169
LONG BEACH CA
90815-2874
US

IV. Provider business mailing address

2051 N BEVERLY PLZ APT 169
LONG BEACH CA
90815-2874
US

V. Phone/Fax

Practice location:
  • Phone: 323-313-3477
  • Fax:
Mailing address:
  • Phone: 323-313-3477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: