Provider Demographics
NPI:1679546006
Name:LUNA, CARMEN IDOLIA (MD)
Entity Type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:IDOLIA
Last Name:LUNA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 4646
Mailing Address - Street 2:
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00694-4646
Mailing Address - Country:US
Mailing Address - Phone:787-858-5151
Mailing Address - Fax:787-858-5151
Practice Address - Street 1:CALLE JULIAN BLANCO SOSA
Practice Address - Street 2:#12
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693
Practice Address - Country:US
Practice Address - Phone:787-858-5151
Practice Address - Fax:787-585-5151
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR9119208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics