Healthcare Provider Details

I. General information

NPI: 1114697265
Provider Name (Legal Business Name): KAYLEE LUNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2021
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1560 BETTY CT
MCKINLEYVILLE CA
95519-4405
US

IV. Provider business mailing address

1560 BETTY CT
MCKINLEYVILLE CA
95519-4405
US

V. Phone/Fax

Practice location:
  • Phone: 707-839-1933
  • Fax:
Mailing address:
  • Phone: 707-839-1933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: