=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649460858
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EMMANUEL C LUNA, M.D., FAAFP, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/25/2007
-----------------------------------------------------
Last Update Date | 01/04/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1500 S CENTRAL AVE SUITE 321
-----------------------------------------------------
City | GLENDALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91204-2530
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-500-0880
-----------------------------------------------------
Fax | 818-500-0221
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1500 S CENTRAL AVE SUITE 321
-----------------------------------------------------
City | GLENDALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91204-2530
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-500-0880
-----------------------------------------------------
Fax | 818-500-0221
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROVIDER
-----------------------------------------------------
Name | DR. EMMANUEL C LUNA
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 818-500-0880
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | A49643
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------