Healthcare Provider Details

I. General information

NPI: 1831650498
Provider Name (Legal Business Name): JAIME LUNA PPS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2019
Last Update Date: 05/09/2025
Certification Date: 05/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

647 HILL ST
OXNARD CA
93033-3118
US

IV. Provider business mailing address

109 CALLE VIS
CAMARILLO CA
93010-1711
US

V. Phone/Fax

Practice location:
  • Phone: 805-385-1545
  • Fax:
Mailing address:
  • Phone: 805-421-8315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number210115940
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: