Healthcare Provider Details

I. General information

NPI: 1952867657
Provider Name (Legal Business Name): PATRICK S LUNA RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2019
Last Update Date: 02/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12605 E 16TH AVE
AURORA CO
80045-2545
US

IV. Provider business mailing address

3034 RIVERWOOD WAY
CASTLE ROCK CO
80109-3807
US

V. Phone/Fax

Practice location:
  • Phone: 720-848-0000
  • Fax:
Mailing address:
  • Phone: 720-788-7414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN.1639235
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: