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General NPI Number Information
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NPI Number | 1255011409
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Entity Type | Organization
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Legal Business Name | LUNA'S CARE LLC
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Dates
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Enumeration Date | 07/21/2023
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Last Update Date | 07/21/2023
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Provider Practice Location Address
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Address Line | 2384 E MAIN ST
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City | STOCKTON
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State | CA
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Zip | 95205-6552
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Country | US
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Telephone | 209-370-3726
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Fax |
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Provider Business Mailing Address
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Address Line | 2384 E MAIN ST
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City | STOCKTON
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State | CA
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Zip | 95205-6552
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Country | US
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Telephone | 209-370-3726
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | NAOMI N FUENTES
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Credential | N/A
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Telephone | 916-370-1291
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number |
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License Number State |
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