Healthcare Provider Details

I. General information

NPI: 1992424030
Provider Name (Legal Business Name): ADRIENNE LYNN LUNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2022
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 BOB BULLOCK LOOP APT 9101
LAREDO TX
78043-4286
US

IV. Provider business mailing address

302 BOB BULLOCK LOOP APT 9101
LAREDO TX
78043-4286
US

V. Phone/Fax

Practice location:
  • Phone: 956-952-0489
  • Fax: 956-568-5105
Mailing address:
  • Phone: 956-952-0489
  • Fax: 956-568-5105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: