MEDICARE: LUNA MEDICAL SUPPLY

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1326158221
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUNA MEDICAL SUPPLY

Provider Business Mailing Address
First Line	:	12218 VICTORY BLVD
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91606-3207
Country	:	US
Telephone Number	:	818-623-8880
Fax Number	:	818-623-8881

Provider Business Practice Location Address
First Line	:	12218 VICTORY BLVD
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91606-3207
Country	:	US
Telephone Number	:	818-623-8880
Fax Number	:	818-623-8881

Authorized Official
Title or Position	:	PRESIDENT/SOLE OWNER
Name	:	HRATCH DERGHAZARIAN
Credential	:
Telephone Number	:	818-623-8880

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	08/22/2020

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