Healthcare Provider Details

I. General information

NPI: 1912837287
Provider Name (Legal Business Name): ANNA LUNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNA ORTIZ

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

766 E 100 N
PAYSON UT
84651-2345
US

IV. Provider business mailing address

412 E MAGELLAN LN
ELK RIDGE UT
84651-9507
US

V. Phone/Fax

Practice location:
  • Phone: 801-980-3676
  • Fax:
Mailing address:
  • Phone: 760-508-2029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12819779-3502
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: