Provider Demographics
NPI:1972109825
Name:LUNA, GIOVANNY
Entity Type:Individual
Prefix:
First Name:GIOVANNY
Middle Name:
Last Name:LUNA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 WILBUR PECK CT
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-6323
Mailing Address - Country:US
Mailing Address - Phone:203-717-1760
Mailing Address - Fax:
Practice Address - Street 1:111 WILBUR PECK CT
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-6323
Practice Address - Country:US
Practice Address - Phone:203-717-1760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker