Healthcare Provider Details

I. General information

NPI: 1063103570
Provider Name (Legal Business Name): LUNA GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2023
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11448 MARQUARDT AVE
WHITTIER CA
90605-3769
US

IV. Provider business mailing address

11448 MARQUARDT AVE
WHITTIER CA
90605-3769
US

V. Phone/Fax

Practice location:
  • Phone: 562-665-3568
  • Fax:
Mailing address:
  • Phone: 562-665-3568
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number113335
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: