Healthcare Provider Details

I. General information

NPI: 1134769821
Provider Name (Legal Business Name): LUNA CASSEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2020
Last Update Date: 01/09/2020
Certification Date: 01/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 BERCUT DR
SACRAMENTO CA
95811-0115
US

IV. Provider business mailing address

6211 DENSLOW WAY
SACRAMENTO CA
95823-4868
US

V. Phone/Fax

Practice location:
  • Phone: 916-443-2479
  • Fax:
Mailing address:
  • Phone: 916-856-4152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: