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General NPI Number Information
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NPI Number | 1386487049
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Entity Type | Organization
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Legal Business Name | LUNA PEDIATRIC AND FAMILY CLINIC, LLC
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Dates
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Enumeration Date | 06/18/2024
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Last Update Date | 07/31/2025
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Provider Practice Location Address
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Address Line | 322 S. BROADWAY, SUITE 4
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City | ELSA
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State | TX
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Zip | 78543
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Country | US
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Telephone | 956-490-9190
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Fax |
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Provider Business Mailing Address
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Address Line | 322 S. BROADWAY, SUITE 4
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City | ELSA
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State | TX
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Zip | 78543
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Country | US
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Telephone | 956-490-9190
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | FERNANDO LUNA
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Credential | FNP
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Telephone | 956-561-8276
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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