Provider Demographics
NPI:1245777945
Name:LUNA, PRISCILLA (RDHAP)
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:
Last Name:LUNA
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7133 KUHL DR
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:CA
Mailing Address - Zip Code:90040-3824
Mailing Address - Country:US
Mailing Address - Phone:562-390-7671
Mailing Address - Fax:
Practice Address - Street 1:7133 KUHL DR
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:CA
Practice Address - Zip Code:90040-3824
Practice Address - Country:US
Practice Address - Phone:562-441-0759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-19
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARDHAP 647124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist