Healthcare Provider Details

I. General information

NPI: 1275273286
Provider Name (Legal Business Name): CRISTOBAL LUNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2022
Last Update Date: 03/29/2022
Certification Date: 03/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6767 W TROPICANA AVE STE 226
LAS VEGAS NV
89103-4911
US

IV. Provider business mailing address

6767 W TROPICANA AVE STE 226
LAS VEGAS NV
89103-4911
US

V. Phone/Fax

Practice location:
  • Phone: 818-521-1848
  • Fax:
Mailing address:
  • Phone: 818-521-1848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246XS1301X
TaxonomySonography Specialist/Technologist Cardiovascular
License NumberRCS.RVS.00070394
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: