Provider Demographics
NPI:1568141158
Name:GARCIA LUNA, SURY YARELY
Entity Type:Individual
Prefix:
First Name:SURY
Middle Name:YARELY
Last Name:GARCIA LUNA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 W LA VETA AVE STE 660
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4244
Mailing Address - Country:US
Mailing Address - Phone:714-509-8210
Mailing Address - Fax:
Practice Address - Street 1:1120 W LA VETA AVE STE 660
Practice Address - Street 2:STE 470
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4244
Practice Address - Country:US
Practice Address - Phone:714-509-7422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-12
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172V00000X
172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker