Provider Demographics
NPI:1023235819
Name:DE LUNA, MIRANDA FAITH (MD)
Entity type:Individual
Prefix:DR
First Name:MIRANDA
Middle Name:FAITH
Last Name:DE LUNA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARANDA
Other - Middle Name:FAITH
Other - Last Name:DE LUNA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:27522 ANTONIO PKWY STE P3
Mailing Address - Street 2:
Mailing Address - City:LADERA RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92694-2166
Mailing Address - Country:US
Mailing Address - Phone:949-207-3786
Mailing Address - Fax:
Practice Address - Street 1:27522 ANTONIO PKWY STE P3
Practice Address - Street 2:
Practice Address - City:LADERA RANCH
Practice Address - State:CA
Practice Address - Zip Code:92694-2166
Practice Address - Country:US
Practice Address - Phone:949-207-3786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA119274207Q00000X
KS432336207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200440150AMedicaid