Healthcare Provider Details

I. General information

NPI: 1629126032
Provider Name (Legal Business Name): LELAND MATTHEW LUNA D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 12/21/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 S SPRUCE AVE STE B
SOUTH SAN FRANCISCO CA
94080-4517
US

IV. Provider business mailing address

161 S SPRUCE AVE STE B
SOUTH SAN FRANCISCO CA
94080-4517
US

V. Phone/Fax

Practice location:
  • Phone: 650-871-5858
  • Fax: 650-871-4834
Mailing address:
  • Phone: 650-871-5858
  • Fax: 650-871-4834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A7091
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: