MEDICARE: ILIANNA MARIE LUNA MS, 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	MT2825	FL

General Provider Information

NPI Number	:	1922396902
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ILIANNA MARIE LUNA MS, LMFT

Provider Business Mailing Address
First Line	:	7520 NW 5TH ST
Second Line	:	SUITE 206
City	:	PLANTATION
State	:	FL
Zip	:	33317-1613
Country	:	US
Telephone Number	:	954-797-7512
Fax Number	:	954-797-7986

Provider Business Practice Location Address
First Line	:	7520 NW 5TH ST
Second Line	:	SUITE 206
City	:	PLANTATION
State	:	FL
Zip	:	33317-1613
Country	:	US
Telephone Number	:	954-797-7512
Fax Number	:	954-797-7986

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

Provider Enumeration Date	:	07/12/2011
Last Update Date	:	11/10/2014

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