Provider Demographics
NPI:1467799569
Name:MANUEL LUNA MD INC
Entity Type:Organization
Organization Name:MANUEL LUNA MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUMMER
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LUNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-871-5858
Mailing Address - Street 1:225 SPRUCE AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-3631
Mailing Address - Country:US
Mailing Address - Phone:650-871-5858
Mailing Address - Fax:650-871-4834
Practice Address - Street 1:225 SPRUCE AVE
Practice Address - Street 2:
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-3631
Practice Address - Country:US
Practice Address - Phone:650-871-5858
Practice Address - Fax:650-871-4834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-09
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC23460207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C234600Medicaid
CA00C234600Medicaid