Provider Demographics
NPI:1760254908
Name:LUNA, TIFFANY CELESTE
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:CELESTE
Last Name:LUNA
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 1:1535 HAWKINS BLVD STE D&E
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-2648
Mailing Address - Country:US
Mailing Address - Phone:915-792-0795
Mailing Address - Fax:
Practice Address - Street 1:1535 HAWKINS BLVD STE D&E
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-2648
Practice Address - Country:US
Practice Address - Phone:915-792-0795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician