Provider Demographics
NPI:1154678696
Name:LUNA, GUILLERMO (PA-C)
Entity Type:Individual
Prefix:
First Name:GUILLERMO
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:PO BOX 3046
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-0746
Mailing Address - Country:US
Mailing Address - Phone:956-586-0333
Mailing Address - Fax:956-586-0707
Practice Address - Street 1:1801 S 5TH ST STE 104
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-2919
Practice Address - Country:US
Practice Address - Phone:956-586-0333
Practice Address - Fax:956-586-0707
Is Sole Proprietor?:No
Enumeration Date:2012-08-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA07820363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3125940-04Medicaid