Provider Demographics
NPI:1639654254
Name:LUNA, GUADALUPE MABEL (MSW)
Entity Type:Individual
Prefix:MRS
First Name:GUADALUPE
Middle Name:MABEL
Last Name:LUNA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2889 ROYAL AVE
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-4759
Mailing Address - Country:US
Mailing Address - Phone:805-657-7128
Mailing Address - Fax:
Practice Address - Street 1:11565 LAUREL CANYON BLVD STE 116
Practice Address - Street 2:
Practice Address - City:SAN FERNANDO
Practice Address - State:CA
Practice Address - Zip Code:91340-4650
Practice Address - Country:US
Practice Address - Phone:818-361-5030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-28
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW1096291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical