Provider Demographics
NPI:1376662163
Name:LUNA, LIZANNE CRUZ (PT)
Entity Type:Individual
Prefix:
First Name:LIZANNE
Middle Name:CRUZ
Last Name:LUNA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7057 WAYMOUTH CT
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-2563
Mailing Address - Country:US
Mailing Address - Phone:909-899-1466
Mailing Address - Fax:
Practice Address - Street 1:1040 W GRAND AVE
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-1904
Practice Address - Country:US
Practice Address - Phone:909-331-7646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32857225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist