Healthcare Provider Details

I. General information

NPI: 1073653309
Provider Name (Legal Business Name): VICENTE A LUNA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1708 SOUTHPOINT DR
CLEVELAND OH
44109-1911
US

IV. Provider business mailing address

1708 SOUTHPOINT DR
CLEVELAND OH
44109-1911
US

V. Phone/Fax

Practice location:
  • Phone: 216-787-0500
  • Fax:
Mailing address:
  • Phone: 216-787-0500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License Number35-056173
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: