Provider Demographics
NPI:1841412368
Name:LUNA, NILSA (PHD)
Entity Type:Individual
Prefix:DR
First Name:NILSA
Middle Name:
Last Name:LUNA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HACIENDA SAN JOSE
Mailing Address - Street 2:88 VIA MIRADERO
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727-3007
Mailing Address - Country:US
Mailing Address - Phone:787-409-1485
Mailing Address - Fax:
Practice Address - Street 1:HACIENDA SAN JOSE
Practice Address - Street 2:88 VIA MIRADERO
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00727-3007
Practice Address - Country:US
Practice Address - Phone:787-409-1485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2005103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0062586Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER