Provider Demographics
NPI:1689801060
Name:LUNA COMMUNITY COLLEGE
Entity Type:Organization
Organization Name:LUNA COMMUNITY COLLEGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:FLORES-MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-454-5328
Mailing Address - Street 1:366 LUNA DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NM
Mailing Address - Zip Code:87701-9838
Mailing Address - Country:US
Mailing Address - Phone:505-454-2500
Mailing Address - Fax:
Practice Address - Street 1:366 LUNA DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-9838
Practice Address - Country:US
Practice Address - Phone:505-454-2500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-12
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty