Provider Demographics
NPI:1760731368
Name:LUNI CORP
Entity Type:Organization
Organization Name:LUNI CORP
Other - Org Name:CLINICA DENTAL
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LUNILDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:REYNOSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-282-5400
Mailing Address - Street 1:420 AVE. PONCE DE LEON
Mailing Address - Street 2:COND. MIDTOWN SUITE 602
Mailing Address - City:HATO REY
Mailing Address - State:PR
Mailing Address - Zip Code:00919
Mailing Address - Country:US
Mailing Address - Phone:787-282-5400
Mailing Address - Fax:
Practice Address - Street 1:420 AVE. PONCE DE LEON
Practice Address - Street 2:COND. MIDTOWN SUITE 602
Practice Address - City:HATO REY
Practice Address - State:PR
Practice Address - Zip Code:00919
Practice Address - Country:US
Practice Address - Phone:787-282-5400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI21551223G0001X
WI19551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty