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NPI Code Detail

MEDICARE: JONATHAN DELA LUNA, MD, LLC

MEDICARE: JONATHAN DELA LUNA, MD, LLC
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
12084P0800XPsychiatry PhysicianMD14529RI

General Provider Information

NPI Number : 1366957631
Entity Type Code : Organization
Provider Name (Legal Business Name) : JONATHAN DELA LUNA, MD, LLC
Provider Business Mailing Address
First Line : 2180 MENDON RD STE 21
Second Line :
City : CUMBERLAND
State : RI
Zip : 02864-3825
Country : US
Telephone Number : 401-333-3810
Fax Number :
Provider Business Practice Location Address
First Line : 2180 MENDON RD STE 21
Second Line :
City : CUMBERLAND
State : RI
Zip : 02864-3825
Country : US
Telephone Number : 401-333-3810
Fax Number :
Authorized Official
Title or Position : MEMBER
Name : DR. JONATHAN VILLAS DELA LUNA
Credential : MD
Telephone Number : 401-333-3810
Provider Enumeration Date : 12/08/2017
Last Update Date : 12/08/2017

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