Healthcare Provider Details

I. General information

NPI: 1205254349
Provider Name (Legal Business Name): DONALD LUNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2014
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 LOMAS BLVD NE MSC 10 6000
ALBUQUERQUE NM
87106
US

IV. Provider business mailing address

800 BRADBURY DR SE STE 116
ALBUQUERQUE NM
87106-4310
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-2610
  • Fax: 505-272-1300
Mailing address:
  • Phone: 505-272-1476
  • Fax: 505-272-1300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD2018-0245
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: