Provider Demographics
NPI:1891020772
Name:LUNA, SOILA DIANA (COTA)
Entity Type:Individual
Prefix:
First Name:SOILA
Middle Name:DIANA
Last Name:LUNA
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 SONRISE PL
Mailing Address - Street 2:APT 201
Mailing Address - City:FELLSMERE
Mailing Address - State:FL
Mailing Address - Zip Code:32948
Mailing Address - Country:US
Mailing Address - Phone:772-321-1806
Mailing Address - Fax:
Practice Address - Street 1:7300 OLEANDER AVE
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952
Practice Address - Country:US
Practice Address - Phone:772-466-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-09
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA10827224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant