=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720949266
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LUNARA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/24/2025
-----------------------------------------------------
Last Update Date | 11/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1233 CALLE EMILIO DELGADO URBANIZACION CLUB MANOR
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00924
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-662-6603
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | #1233 URBANIZACION CLUB MANOR CALLE EMILIO DELGADO
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00924
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-662-6603
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FUNDADORA/ CONSEJERA PROFESIONAL
-----------------------------------------------------
Name | MRS. KAMILLE M RIVERA MENDEZ
-----------------------------------------------------
Credential | CPLP 1744
-----------------------------------------------------
Telephone | 787-662-6603
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------