Provider Demographics
NPI:1780036368
Name:LUNA, ROBERTO DEMIAN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:DEMIAN
Last Name:LUNA
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 GILMAN DRIVE #0304
Mailing Address - Street 2:UNIVERSITY OF CALIFORNIA SAN DIEGO
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92093-0304
Mailing Address - Country:US
Mailing Address - Phone:858-534-3755
Mailing Address - Fax:
Practice Address - Street 1:9500 GILMAN DRIVE #0304
Practice Address - Street 2:UNIVERSITY OF CALIFORNIA SAN DIEGO
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92093-0304
Practice Address - Country:US
Practice Address - Phone:858-534-3755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-07
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY29183103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical