Provider Demographics
NPI:1508013855
Name:LUNA, MONICA RAE (DOM)
Entity Type:Individual
Prefix:DR
First Name:MONICA
Middle Name:RAE
Last Name:LUNA
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2323 CALLE LUMINOSO
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-5609
Mailing Address - Country:US
Mailing Address - Phone:505-231-6236
Mailing Address - Fax:505-424-1426
Practice Address - Street 1:18468C PRIVATE DRIVE
Practice Address - Street 2:
Practice Address - City:ARROYO SECO
Practice Address - State:NM
Practice Address - Zip Code:87532
Practice Address - Country:US
Practice Address - Phone:505-753-7576
Practice Address - Fax:505-753-7575
Is Sole Proprietor?:No
Enumeration Date:2008-08-19
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
NM963171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician