Provider Demographics
NPI:1013542687
Name:PRADO LUNA, GRISELL ANGELICA
Entity Type:Individual
Prefix:
First Name:GRISELL
Middle Name:ANGELICA
Last Name:PRADO LUNA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 ARCADIA DR
Mailing Address - Street 2:
Mailing Address - City:PACIFICA
Mailing Address - State:CA
Mailing Address - Zip Code:94044-1002
Mailing Address - Country:US
Mailing Address - Phone:650-826-7130
Mailing Address - Fax:
Practice Address - Street 1:121 ARCADIA DR
Practice Address - Street 2:
Practice Address - City:PACIFICA
Practice Address - State:CA
Practice Address - Zip Code:94044-1002
Practice Address - Country:US
Practice Address - Phone:650-826-7130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-04
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health