MEDICARE: SYLVIA ANN LUNA LPT

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	167G00000X	Licensed Psychiatric Technician	PT18971	CA

General Provider Information

NPI Number	:	1487853966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SYLVIA ANN LUNA LPT

Provider Business Mailing Address
First Line	:	8753 PALMCREEK DR
Second Line	:
City	:	SO.SAN GABRIEL
State	:	CA
Zip	:	91770
Country	:	US
Telephone Number	:	626-403-4381
Fax Number	:

Provider Business Practice Location Address
First Line	:	1499 HUNTINGTON DR
Second Line	:	SUITE 101
City	:	SOUTH PASADENA
State	:	CA
Zip	:	91030-4552
Country	:	US
Telephone Number	:	626-403-4381
Fax Number	:

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

Provider Enumeration Date	:	07/13/2007
Last Update Date	:	07/13/2007

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