Provider Demographics
NPI:1083746648
Name:LUNA, LOUIS JOSE (LBSW)
Entity Type:Individual
Prefix:MR
First Name:LOUIS
Middle Name:JOSE
Last Name:LUNA
Suffix:
Gender:M
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 S COPPER ST
Mailing Address - Street 2:PO BOX 792
Mailing Address - City:DEMING
Mailing Address - State:NM
Mailing Address - Zip Code:88030-4601
Mailing Address - Country:US
Mailing Address - Phone:505-544-8712
Mailing Address - Fax:505-544-0072
Practice Address - Street 1:809 S COPPER ST
Practice Address - Street 2:
Practice Address - City:DEMING
Practice Address - State:NM
Practice Address - Zip Code:88030-4601
Practice Address - Country:US
Practice Address - Phone:505-544-8712
Practice Address - Fax:505-544-0072
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMB-2768251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1394OtherBUSSINESS NUMBER
NMB-2768OtherSOCIAL WORK