Provider Demographics
NPI:1215196217
Name:LUNA, JESUS JAVIER (PHD)
Entity Type:Individual
Prefix:DR
First Name:JESUS
Middle Name:JAVIER
Last Name:LUNA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:J.
Other - Middle Name:JAVIER
Other - Last Name:LUNA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:23 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WINTERS
Mailing Address - State:CA
Mailing Address - Zip Code:95694-1722
Mailing Address - Country:US
Mailing Address - Phone:530-795-4377
Mailing Address - Fax:530-795-3054
Practice Address - Street 1:23 MAIN ST
Practice Address - Street 2:
Practice Address - City:WINTERS
Practice Address - State:CA
Practice Address - Zip Code:95694-1722
Practice Address - Country:US
Practice Address - Phone:530-795-4377
Practice Address - Fax:530-795-3054
Is Sole Proprietor?:No
Enumeration Date:2008-06-04
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25189103TC0700X, 103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service