Healthcare Provider Details

I. General information

NPI: 1023453370
Provider Name (Legal Business Name): ROXANNE LUNA B.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2013
Last Update Date: 08/24/2020
Certification Date: 08/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5150 E PACIFIC COAST HWY SUITE 100
LONG BEACH CA
90804
US

IV. Provider business mailing address

5150 E PACIFIC COAST HWY SUITE 100
LONG BEACH CA
90804-3312
US

V. Phone/Fax

Practice location:
  • Phone: 562-490-7600
  • Fax: 562-490-7601
Mailing address:
  • Phone: 562-490-7600
  • Fax: 562-490-7601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number82039
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number120774
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: