Provider Demographics
NPI:1174292288
Name:LUNA, HAYDEE C (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:HAYDEE
Middle Name:C
Last Name:LUNA
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1519 CAMINITO SORIA # 2
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-2503
Mailing Address - Country:US
Mailing Address - Phone:619-864-0363
Mailing Address - Fax:
Practice Address - Street 1:1519 CAMINITO SORIA # 2
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91913-2503
Practice Address - Country:US
Practice Address - Phone:619-864-0363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-10
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9608225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist