Provider Demographics
NPI:1245429422
Name:LUNA, MARIO ELISEO (MD)
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:ELISEO
Last Name:LUNA
Suffix:
Gender:M
Credentials:MD
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 1030
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92564-1030
Mailing Address - Country:US
Mailing Address - Phone:951-600-1795
Mailing Address - Fax:951-600-1798
Practice Address - Street 1:39755 DATE ST STE 104
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-2007
Practice Address - Country:US
Practice Address - Phone:951-600-1795
Practice Address - Fax:951-308-1522
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-23
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA92302207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery