Healthcare Provider Details

I. General information

NPI: 1821813288
Provider Name (Legal Business Name): ILSA MARIE LUNA-FLORES RNFA,RN,CNOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2024
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 SPRUCE ST
PHILADELPHIA PA
19107-6192
US

IV. Provider business mailing address

644 EMILY ST
PHILADELPHIA PA
19148-2413
US

V. Phone/Fax

Practice location:
  • Phone: 661-993-8396
  • Fax:
Mailing address:
  • Phone: 661-993-8396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN653234
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: