Healthcare Provider Details

I. General information

NPI: 1811777980
Provider Name (Legal Business Name): ALEXIS BRIANNA LUNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2023
Last Update Date: 10/04/2023
Certification Date: 10/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 SE 4TH ST STE B
MOORE OK
73160-7328
US

IV. Provider business mailing address

1601 COLLEGE AVE
OKLAHOMA CITY OK
73106-4434
US

V. Phone/Fax

Practice location:
  • Phone: 405-338-7674
  • Fax:
Mailing address:
  • Phone: 810-877-0113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: