Provider Demographics
NPI:1639485360
Name:LUNA, STEPHEN (LMP)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:LUNA
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2310 N MOLTER RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-5036
Mailing Address - Country:US
Mailing Address - Phone:509-924-4443
Mailing Address - Fax:
Practice Address - Street 1:2310 N MOLTER RD
Practice Address - Street 2:SUITE 108
Practice Address - City:LIBERTY LAKE
Practice Address - State:WA
Practice Address - Zip Code:99019-5036
Practice Address - Country:US
Practice Address - Phone:509-924-4443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-18
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60148628171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor