Provider Demographics
NPI:1356673842
Name:JULIETA JOSON-LUNA MD SC
Entity Type:Organization
Organization Name:JULIETA JOSON-LUNA MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JULIETA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSON-LUNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-286-1464
Mailing Address - Street 1:5906 W MONTROSE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-1625
Mailing Address - Country:US
Mailing Address - Phone:773-286-1464
Mailing Address - Fax:773-286-4001
Practice Address - Street 1:5906 W MONTROSE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-1625
Practice Address - Country:US
Practice Address - Phone:773-286-1464
Practice Address - Fax:773-286-4001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-08
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036049534261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1104991413OtherNPI TYPE 1
IL036049534Medicaid
C42247Medicare UPIN
IL487631Medicare PIN