Provider Demographics
NPI:1093362634
Name:LUNA, EDLIN AURORA
Entity Type:Individual
Prefix:
First Name:EDLIN
Middle Name:AURORA
Last Name: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 1:1750 142ND AVE
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-1712
Mailing Address - Country:US
Mailing Address - Phone:510-316-7345
Mailing Address - Fax:
Practice Address - Street 1:1750 142ND AVE
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-1712
Practice Address - Country:US
Practice Address - Phone:510-316-7345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-19
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician