Provider Demographics
NPI:1073196820
Name:LUNA, MILYCEL (SA-C)
Entity Type:Individual
Prefix:
First Name:MILYCEL
Middle Name:
Last Name:LUNA
Suffix:
Gender:F
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:547 CAMBRIDGE ST APT 1
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01610-2673
Mailing Address - Country:US
Mailing Address - Phone:774-778-4091
Mailing Address - Fax:
Practice Address - Street 1:547 CAMBRIDGE ST APT 1
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01610-2673
Practice Address - Country:US
Practice Address - Phone:774-778-4091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI19-312246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant