MEDICARE: MS. MARIA GRACIELA LUNA M.A, BCBA, LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	77130	CA
2	103K00000X	Behavior Analyst	1-12-10097	CA

General Provider Information

NPI Number	:	1215202676
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARIA GRACIELA LUNA M.A, BCBA, LMFT

Provider Business Mailing Address
First Line	:	1161 DOLPHIN DR
Second Line	:
City	:	PERRIS
State	:	CA
Zip	:	92571-4920
Country	:	US
Telephone Number	:	858-444-8823
Fax Number	:	858-444-8827

Provider Business Practice Location Address
First Line	:	8787 COMPLEX DR STE 300
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-1453
Country	:	US
Telephone Number	:	619-797-1090
Fax Number	:	858-444-8827

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2012
Last Update Date	:	05/03/2022

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