Provider Demographics
NPI:1386685238
Name:LUNA, HARRISON (PA-C)
Entity Type:Individual
Prefix:MR
First Name:HARRISON
Middle Name:
Last Name:LUNA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4338 EMORY RD
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79922-1109
Mailing Address - Country:US
Mailing Address - Phone:800-444-7009
Mailing Address - Fax:
Practice Address - Street 1:801 N BEDELL AVE
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:DEL RIO
Practice Address - State:TX
Practice Address - Zip Code:78840-4112
Practice Address - Country:US
Practice Address - Phone:830-703-1702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01342363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXS20566Medicare UPIN