MEDICARE: ZITA LUNA-BANIQUED M.D.

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	171W00000X	Contractor	A37780	CA

General Provider Information

NPI Number	:	1669536686
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZITA LUNA-BANIQUED M.D.

Provider Business Mailing Address
First Line	:	1605 AMOUR DR
Second Line	:
City	:	LEESVILLE
State	:	LA
Zip	:	71446-5212
Country	:	US
Telephone Number	:	337-238-9317
Fax Number	:	337-531-3709

Provider Business Practice Location Address
First Line	:	1585 THIRD ST.
Second Line	:	BAYNE JONES ACH
City	:	FORT POLK
State	:	LA
Zip	:	71459-5110
Country	:	US
Telephone Number	:	337-531-3074
Fax Number	:	337-531-3709

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

Provider Enumeration Date	:	12/21/2006
Last Update Date	:	07/08/2007

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