Provider Demographics
NPI:1164790697
Name:LUNA, VIVIANETTE (LND)
Entity Type:Individual
Prefix:MS
First Name:VIVIANETTE
Middle Name:
Last Name:LUNA
Suffix:
Gender:F
Credentials:LND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 CALLE CALAF
Mailing Address - Street 2:SUITE 361
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-1314
Mailing Address - Country:US
Mailing Address - Phone:787-993-2566
Mailing Address - Fax:
Practice Address - Street 1:400 CALLE CALAF
Practice Address - Street 2:SUITE 361
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-1314
Practice Address - Country:US
Practice Address - Phone:787-993-2566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-12
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1644133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist