Healthcare Provider Details

I. General information

NPI: 1114362290
Provider Name (Legal Business Name): ANNETTE LUNA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2013
Last Update Date: 05/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 W 5TH ST STE 300
SANTA ANA CA
92701-4599
US

IV. Provider business mailing address

2600 W LA HABRA BLVD APT 245
LA HABRA CA
90631-1966
US

V. Phone/Fax

Practice location:
  • Phone: 714-834-3101
  • Fax: 714-834-4445
Mailing address:
  • Phone: 562-222-9645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number761261
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: