Provider Demographics
NPI:1578823019
Name:LUNA, SOLANGE GRACE (BA)
Entity Type:Individual
Prefix:MISS
First Name:SOLANGE
Middle Name:GRACE
Last Name:LUNA
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5711 S DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-3602
Mailing Address - Country:US
Mailing Address - Phone:305-667-1036
Mailing Address - Fax:305-234-5459
Practice Address - Street 1:5711 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-3602
Practice Address - Country:US
Practice Address - Phone:305-667-1036
Practice Address - Fax:305-234-5459
Is Sole Proprietor?:No
Enumeration Date:2012-05-17
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker