Provider Demographics
NPI:1639707672
Name:LUNA, YVONNE MARIE (CMT)
Entity Type:Individual
Prefix:
First Name:YVONNE
Middle Name:MARIE
Last Name:LUNA
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 196
Mailing Address - Street 2:
Mailing Address - City:TWIN PEAKS
Mailing Address - State:CA
Mailing Address - Zip Code:92391-0196
Mailing Address - Country:US
Mailing Address - Phone:909-742-9838
Mailing Address - Fax:
Practice Address - Street 1:25268 CA-18
Practice Address - Street 2:
Practice Address - City:CRESTLINE
Practice Address - State:CA
Practice Address - Zip Code:92325
Practice Address - Country:US
Practice Address - Phone:909-742-9838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-27
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA74659225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist