Healthcare Provider Details

I. General information

NPI: 1487853966
Provider Name (Legal Business Name): SYLVIA ANN LUNA LPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2007
Last Update Date: 07/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1499 HUNTINGTON DR SUITE 101
SOUTH PASADENA CA
91030-4552
US

IV. Provider business mailing address

8753 PALMCREEK DR
SO.SAN GABRIEL CA
91770
US

V. Phone/Fax

Practice location:
  • Phone: 626-403-4381
  • Fax:
Mailing address:
  • Phone: 626-403-4381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License NumberPT18971
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: