Provider Demographics
NPI:1710550736
Name:RODRIGUEZ, LUNA ABRIL
Entity Type:Individual
Prefix:
First Name:LUNA
Middle Name:ABRIL
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1253 E FOREST RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-5750
Mailing Address - Country:US
Mailing Address - Phone:425-209-8653
Mailing Address - Fax:
Practice Address - Street 1:1253 E FOREST RIDGE RD
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094-5750
Practice Address - Country:US
Practice Address - Phone:425-209-8653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT05Medicaid