Healthcare Provider Details

I. General information

NPI: 1154301703
Provider Name (Legal Business Name): MARTHA LUNA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 N FRIO ST
SAN ANTONIO TX
78207-3034
US

IV. Provider business mailing address

7111 FAIRWAY DR SUITE 400
PALM BEACH GARDENS FL
33418-4204
US

V. Phone/Fax

Practice location:
  • Phone: 210-271-3111
  • Fax: 210-735-1305
Mailing address:
  • Phone: 561-712-6265
  • Fax: 561-712-7349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberJ7814
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: