Provider Demographics
NPI:1679901912
Name:DE LUNA, MIGUEL JR
Entity Type:Individual
Prefix:MR
First Name:MIGUEL
Middle Name:
Last Name:DE LUNA
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 DOVER ST
Mailing Address - Street 2:SUITE A1
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77087-4693
Mailing Address - Country:US
Mailing Address - Phone:713-649-1200
Mailing Address - Fax:713-649-1201
Practice Address - Street 1:4000 DOVER ST
Practice Address - Street 2:SUITE A1
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77087-4693
Practice Address - Country:US
Practice Address - Phone:713-649-1200
Practice Address - Fax:713-649-1201
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-24
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3659-3660101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)