Provider Demographics
NPI:1821877721
Name:LUNA, ANDREW JAMES (PA)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:JAMES
Last Name:LUNA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:900 E WASHINGTON ST STE 301
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-8182
Mailing Address - Country:US
Mailing Address - Phone:909-370-0300
Mailing Address - Fax:909-370-0303
Practice Address - Street 1:900 E WASHINGTON ST STE 301
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-8182
Practice Address - Country:US
Practice Address - Phone:909-370-0300
Practice Address - Fax:909-370-0303
Is Sole Proprietor?:No
Enumeration Date:2023-09-28
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA63605363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical