Provider Demographics
NPI:1629126032
Name:LUNA, LELAND MATTHEW (DO)
Entity Type:Individual
Prefix:DR
First Name:LELAND
Middle Name:MATTHEW
Last Name:LUNA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 S SPRUCE AVE STE B
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-4517
Mailing Address - Country:US
Mailing Address - Phone:650-871-5858
Mailing Address - Fax:650-871-4834
Practice Address - Street 1:161 S SPRUCE AVE STE B
Practice Address - Street 2:
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-4517
Practice Address - Country:US
Practice Address - Phone:650-871-5858
Practice Address - Fax:650-871-4834
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7091207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY415330Medicaid
CA1871690016Medicaid
CA1548336423Medicare UPIN
CA1881609436Medicare UPIN
CA1386643856Medicare UPIN
CA1437188208Medicare UPIN
CA0917720001Medicare UPIN
CA1871690016Medicaid
CA0917720001Medicare NSC
CA1144339748Medicare UPIN
CA1275703571Medicare UPIN
CA1578585410Medicare UPIN
CA1063487304Medicare UPIN
CA1255531570Medicare UPIN
CA1801869532Medicare UPIN
CAPHY415330Medicaid