Provider Demographics
NPI:1457457756
Name:LUNA, NATHAN
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:LUNA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1465 65TH ST
Mailing Address - Street 2:# 201
Mailing Address - City:EMERYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94608-1062
Mailing Address - Country:US
Mailing Address - Phone:510-594-1816
Mailing Address - Fax:
Practice Address - Street 1:4460 E HUNTINGTON AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93702-2962
Practice Address - Country:US
Practice Address - Phone:559-459-4300
Practice Address - Fax:559-459-4569
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA82622208000000X, 2080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A826220Medicaid
CA00A826220Medicaid
CAL10069Medicare UPIN