Provider Demographics
NPI:1295392777
Name:LUNA, LUZ D (LMT, MMP)
Entity Type:Individual
Prefix:
First Name:LUZ
Middle Name:D
Last Name:LUNA
Suffix:
Gender:F
Credentials:LMT, MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 BOSTWICK AVE # 2
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07305-3416
Mailing Address - Country:US
Mailing Address - Phone:201-838-0710
Mailing Address - Fax:
Practice Address - Street 1:289 GROVE ST # 2
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-3602
Practice Address - Country:US
Practice Address - Phone:201-838-0710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-21
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT01186200225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist