Provider Demographics
NPI:1093406985
Name:LUNA, SALVADOR (PA-C)
Entity Type:Individual
Prefix:
First Name:SALVADOR
Middle Name:
Last Name:LUNA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1832 S 324TH PL
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-8505
Mailing Address - Country:US
Mailing Address - Phone:253-835-8979
Mailing Address - Fax:
Practice Address - Street 1:2913 5TH AVE NE STE 101
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-6748
Practice Address - Country:US
Practice Address - Phone:855-255-1750
Practice Address - Fax:855-255-0905
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-19
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA61459657363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant