Provider Demographics
NPI:1467182113
Name:LUNA MEZA, LUIS T
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:T
Last Name:LUNA MEZA
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 1:438 EDDIE LN
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-3425
Mailing Address - Country:US
Mailing Address - Phone:707-823-8722
Mailing Address - Fax:
Practice Address - Street 1:1534 HURLBUT AVE
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-2877
Practice Address - Country:US
Practice Address - Phone:707-823-0282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor